Clinical outcomes of bortezomib-based desensitization in highly sensitized living and deceased donor kidney transplantation

Abstract

Background: Sensitization acts as an immunological barrier to successful kidney transplantation (KT). We aim to investigate the efficacy and safety of bortezomib-based desensitization (BOZ-DSZ) in both highly sensitized living donor KT (LDKT) and deceased donor KT (DDKT).

Methods: We applied BOZ-DSZ to 20 highly sensitized patients-14 LDKT and six DDKT candidates-and analyzed the change in anti-human leukocyte antigen (HLA) antibody, the success rate of transplantation, and posttransplant outcomes including biopsy-proven allograft rejection (BPAR) rate, infectious complication, and allograft survival.

Results: Among 14 LDKT candidates, the peak mean fluorescence intensity (MFI) level of donor-specific anti-HLA antibody (HLA-DSA) decreased in 10 patients (p < 0.05), and the success rate of KT was 92.9% (13 of 14). Incidence of BPAR within the first posttransplant year was 53.8% (7 of 13), and all such cases were rescued by antirejection treatment. One case resulted in mortality due to pneumonia, and there was one allograft failure during the follow-up of 34 months (range, 6-129 months). Among the six DDKT candidates, the peak MFI level of HLA-DSA showed a significant decrease after DSZ in five patients (p = 0.098), and the success rate of KT was 50.0% (3 of 6). One BPAR case (33.3%) occurred within the first posttransplant year and was successfully treated. There was one case of Cytomegalovirus viremia, and there was no allograft failure during the 36-month follow-up (range, 17-42 months). Conclusion BOZ-DSZ is effective and safe in terms of successful DSZ, infectious complications, and allograft outcomes for both highly sensitized LDKT and DDKT candidates.

Keywords: Bortezomib; Desensitization; Kidney transplantation; Sensitization; Treatment outcome.