A Banff Component Scoring-based Histologic Assessment of Bortezomib-based Antibody-mediated Rejection Therapy

Abstract

These results show that: (1) Banff component scoring provides insights into histologic responses to AMR therapy and may provide a potential endpoint for clinical AMR trials. (2) Early and late AMR demonstrate differences in acute and chronic Banff components at the time of the AMR diagnostic biopsy, as well as differential responses to AMR therapy.

Bortezomib for refractory acute antibody‐mediated rejection in kidney transplant recipients: A single‐centre case series

“…More recently, new approaches to evaluating renal response after ABMR treatment have emerged and the use of a scoring system based on Banff components for histologic assessment could be helpful for a more accurate evaluation of renal response, although more evidence is still needed. 18 Similar to previous reports, 6,9,[19][20][21] DSA titres significantly decreased in our series, but DSA remained positive in three out of five patients, and two experienced a rebound 4 and 6 months after bortezomib. The effect of bortezomib on DSA is probably due to its ability to deplete plasma cells, thus reducing DSA titres, especially when combined in multimodal therapeutic regimens (including IVIG, rituximab, steroids and/or plasmapheresis) 22 and hence bortezomib has been successfully used for desensitization in highly sensitized patients prior to kidney transplantation.…”

“…In our series, most of our patients developed lesions of chronic active humoral rejection soon after treatment, and two patients developed renal function deterioration with persistent ABMR requiring further treatment later in the follow‐up (12 and 40 months). Early appearance of chronic ABMR within a few weeks after therapy has been described previously, is not uncommon after aggressive rejection episodes, and is associated with poor graft survival . This observation of rapid progression to chronic ABMR argues for more aggressive and effective therapeutic approaches to ensure better graft survival.…”

“…Early appearance of chronic ABMR within a few weeks after therapy has been described previously, is not uncommon after aggressive rejection episodes, and is associated with poor graft survival. 9,18 This observation of rapid progression to chronic ABMR argues for more aggressive and effective therapeutic approaches to ensure better graft survival. More recently, new approaches to evaluating renal response after ABMR treatment have emerged and the use of a scoring system based on Banff components for histologic assessment could be helpful for a more accurate evaluation of renal response, although more evidence is still needed.…”

Rituximab in Combination With Bortezomib, Plasmapheresis, and High-Dose IVIG to Treat Antibody-Mediated Renal Allograft Rejection

“…This may be important because acute lesions seem to respond better to treatment than chronic lesions. 25 However, in the present study, graft survival was not different in patients with acute and chronic lesions as compared with patients (7/21) with exclusively acute lesions ( P = 0.35).…”

The Preliminary Results of Bortezomib Used as A Primary Treatment for An Early Acute Antibody-Mediated Rejection after Kidney Transplantation—A Single-Center Case Series

“…As the plasma cells are the main source of antibody production, the proteasome inhibitor, bortezomib (Velcade ® , Milennium Pharmaceuticals, Cambridge, MA, USA), had been introduced into the AMR treatment, mostly as a rescue therapy in refractory cases [7][8][9][10]. In general, kidney graft outcomes were significantly better in acute than chronic AMR [8,[10][11][12]. In some reports, such an adjuvant therapy was effective in decreasing DSAs and stabilizing kidney graft function in mid-term observation [7,9].…”