Throughout the past years we stepwise modified our immunosuppressive treatment
regimen for patients with antibody-mediated rejection (ABMR). Here, we
describe three consecutive groups treated with different regimens. From 2005
until 2008, we treated all patients with biopsy-proven ABMR with rituximab
(500 mg), low-dose (30 g) intravenous immunoglobulins (IVIG), and
plasmapheresis (PPH, 6x) (group RLP, ). Between 2009 and June 2010, patients
received bortezomib (1.3 mg/m2, 4x) together with low-dose IVIG and PPH (group
BLP, ). In July 2010, we increased the IVIG dose and treated all subsequent
patients with bortezomib, high-dose IVIG (1.5 g/kg), and PPH (group BHP, ).
Graft survival at three years after treatment was 73% in group BHP as compared
to 45% in group BLP and 25% in group RLP. At six months after treatment median
serum creatinine was 2.1 mg/dL, 2.9 mg/dL, and 4.2 mg/dL in groups BHP, BLP,
and RLP, respectively (). Following treatment, a significant decrease of
donor-specific HLA antibody (DSA) mean fluorescence intensity from to () was
observed in group BHP, but not in the other groups. Our results indicate that
graft survival, graft function, and DSA levels could be improved along with
stepwise modifications to our treatment regimen, that is, the introduction of
bortezomib and high-dose IVIG treatment
