1. Bortezomib Against Refractory Antibody-Mediated Rejection After ABO-Incompatible Living-Donor Liver Transplantation: Dramatic Effect in Acute-Phase?
- Author
-
Tetsuya Tajima, MD, Koichiro Hata, MD, PhD, Hideaki Okajima, MD, PhD, Momoko Nishikori, MD, PhD, Kentaro Yasuchika, MD, PhD, Jiro Kusakabe, MD, Atsushi Yoshizawa, MD, PhD, Ken Fukumitsu, MD, PhD, Takayuki Anazawa, MD, PhD, Hirokazu Tanaka, MD, Seidai Wada, MD, PhD, Junshi Doi, MD, Akifumi Takaori-Kondo, MD, PhD, and Shinji Uemoto, MD, PhD
- Subjects
Surgery ,RD1-811 - Abstract
Antibody-mediated rejection (AMR) is a refractory rejection after donor-specific antibody-positive or ABO blood-type incompatible (ABOi) organ transplantation. Rituximab dramatically improved the outcome of ABOi living-donor liver transplantation (LDLT); however, an effective treatment for posttransplant AMR, once occurred, is yet to be established. A 44-year-old woman with biliary cirrhosis underwent ABOi-LDLT from her sister (AB-to-A). Pretransplant rituximab diminished CD19/20-positive B lymphocytes to 0.6%/0.0%; however, AMR occurred on posttransplant day-6 with marked increase in both CD19/20 cells (17.1%/5.8%) and anti-B IgM/G-titers (1024/512). Despite rituximab readministration, steroid-pulse, intravenous immunoglobulin, and plasmapheresis, AMR was uncontrollable, with further increasing CD19/20 cells (23.0%/0.0%) and antibody-titers (2048/512). Bortezomib (1.0 mg/m2) was thus administered on posttransplant day-9, immediately ameliorating CD19/20 cells (1.3%/0.0%) and antibody-titers (
- Published
- 2019
- Full Text
- View/download PDF