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Effectiveness of Bortezomib in a Patient With Acute Rejection Associated With an Elevation of Donor-Specific HLA Antibodies After Small-Bowel Transplantation: Case Report
- Source :
- Transplantation Proceedings. 48:525-527
- Publication Year :
- 2016
- Publisher :
- Elsevier BV, 2016.
-
Abstract
- Background A significant association between donor-specific antibody (DSA) and graft rejection has recently been documented. However, confirmed strategy has not been established for DSA-associated rejection after intestinal transplantation (ITx). Case Report A 20-year-old male patient with chronic intestinal obstruction caused by hypoganglionosis of the entire intestine underwent cadaveric donor ITx with grafting performed on 232 cm of the small intestine, cecum, and a part of the ascending colon. On post-operative day (POD) 14, a histological evaluation showed an acute rejection of indeterminate grade. The patient had severe acute rejection on POD 16, which prompted us to administer bolus steroids and polyclonal anti-thymocyte antibody, along with baseline maintenance immunosuppression. The histopathological findings of the graft indicated typical acute cellular rejection, although C4d was positive. We then detected donor-specific HLA antibody. The patient initially responded well to the therapy and showed decreased histological rejection signs. However, the refractory low-grade rejection persisted in the graft. During this period, the patient showed increased levels of DSA, and we speculated that the persistent rejection was associated with DSA; thus, bortezomib was administered at this stage as a salvage therapy. This rejection was thereafter successfully controlled without severe adverse effect. Twenty-three months after ITx, the patient is currently alive with complete enteral autonomy. Conclusions A case of acute graft rejection followed by a marked elevation of DSA is presented. In this particular case, a modified treatment protocol using bortezomib in addition to the typical immunosuppressive agents was effective.
- Subjects :
- Graft Rejection
Male
medicine.medical_specialty
medicine.medical_treatment
Salvage therapy
Antineoplastic Agents
030230 surgery
Gastroenterology
Antibodies
Bortezomib
Young Adult
03 medical and health sciences
Cecum
0302 clinical medicine
Bolus (medicine)
HLA Antigens
Internal medicine
Intestine, Small
medicine
Humans
Ascending colon
Adverse effect
Immunosuppression Therapy
Transplantation
business.industry
Histocompatibility Testing
Immunosuppression
Tissue Donors
Surgery
medicine.anatomical_structure
Acute Disease
030211 gastroenterology & hepatology
business
medicine.drug
Subjects
Details
- ISSN :
- 00411345
- Volume :
- 48
- Database :
- OpenAIRE
- Journal :
- Transplantation Proceedings
- Accession number :
- edsair.doi.dedup.....5ef9b0ddfcfd2015c6170b84e94d2177