Bortezomib Against Refractory Antibody-Mediated Rejection After ABO-Incompatible Living-Donor Liver Transplantation: Dramatic Effect in Acute-Phase?
Bortezomib Against Refractory Antibody-Mediated Rejection After ABO-Incompatible Living-Donor Liver Transplantation: Dramatic Effect in Acute-Phase?
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DOI：
10.1097/txd.0000000000000932
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发表时间：
2019-10-01
影响因子：
2.3
通讯作者：
Uemoto, Shinji
中科院分区：
文献类型：
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作者：
Tajima, Tetsuya;Hata, Koichiro;Uemoto, Shinji
抗体介导的排斥反应（Antibody-mediated rejection，AMR）是供者特异性抗体阳性或ABO血型不合（ABO blood-type incompatible，ABOi）器官移植后的一种难治性排斥反应。利妥昔单抗显著改善了ABOi活体肝移植（LDLT）的结局;然而，一旦发生移植后AMR，尚未建立有效的治疗方法。一名患有胆汁性肝硬化的44岁女性接受了其姐姐的ABOi-LDLT（AB-至-A）。移植前利妥昔单抗将CD 19/20阳性B淋巴细胞减少至0.6%/0.0%;然而，移植后第6天发生AMR，CD 19/20细胞（17.1%/5.8%）和抗B IgM/G滴度（1024/512）均显著增加。尽管利妥昔单抗再次给药、类固醇脉冲、静脉注射免疫球蛋白和血浆置换，AMR仍无法控制，CD 19/20细胞（23.0%/0.0%）和抗体滴度（2048/512）进一步升高。因此，在移植后第9天给予硼替佐米（1.0 mg/m2），立即改善CD 19/20细胞（1.3%/0.0%）和抗体滴度（
Antibody-mediated rejection (AMR) is a refractory rejection after donor-specific antibody-positive or ABO blood-type incompatible (ABOi) organ transplantation. Rituximab dramatically improved the outcome of ABOi living-donor liver transplantation (LDLT); however, an effective treatment for posttransplant AMR, once occurred, is yet to be established. A 44-year-old woman with biliary cirrhosis underwent ABOi-LDLT from her sister (AB-to-A). Pretransplant rituximab diminished CD19/20-positive B lymphocytes to 0.6%/0.0%; however, AMR occurred on posttransplant day-6 with marked increase in both CD19/20 cells (17.1%/5.8%) and anti-B IgM/G-titers (1024/512). Despite rituximab readministration, steroid-pulse, intravenous immunoglobulin, and plasmapheresis, AMR was uncontrollable, with further increasing CD19/20 cells (23.0%/0.0%) and antibody-titers (2048/512). Bortezomib (1.0 mg/m(2)) was thus administered on posttransplant day-9, immediately ameliorating CD19/20 cells (1.3%/0.0%) and antibody-titers (