Bortezomib-Containing Regimen for Primary Treatment of Early Antibody-Mediated Cardiac Allograft Rejection: A Case Report

Abstract

Evidence regarding the use of bortezomib-containing schemes in primary treatment of antibody-mediated rejection in heart transplant recipients is scarce. This case report presents the clinical experience with upstream use of bortezomib in primary treatment of early antibody-mediated rejection in an adult heart transplant recipient. Two cycles of bortezomib together with methylprednisolone, immunoadsorption, rituximab, and supplementary doses of intravenous immunoglobulin G reversed signs of heart failure, production of donor-specific antibodies, and findings of antibody-mediated rejection in biopsy. This treatment regimen was tolerated with only mild hematologic toxicity and proved to be successful during a 12-month follow-up. Primary treatment with a bortezomib-containing regimen appears to be a new therapeutic option for severe antibody-mediated rejection in heart transplant recipients. However, the efficacy and safety of this treatment need to be tested in prospective trials.

Novel insights into pretransplant allosensitization in heart transplant recipients in the contemporary era of immunosuppression and rejection surveillance

“…Clinical and echocardiographic follow‐up was guided mainly by screening endomyocardial biopsies in the initial postoperative period, as reported previously . A total of 3270 biopsy procedures were performed.…”

“…Endomyocardial biopsy specimens were routinely stained with hematoxylin–eosin. Immunohistochemistry was performed on 3‐μm‐thick paraffin sections using immunoperoxidase‐based indirect method to detect C4d deposition and CD 68 expression on macrophages, as reported previously . Acute cellular rejection was graded both according to the 1990 and the 2005 ISHLT classification , and AMR was evaluated using the 2005 ISHLT classification .…”