Successful Treatment of Plasma Cell-Rich Acute Rejection Using Bortezomib: A Case Report
Plasma cell-rich acute rejection (PCAR), a relatively rare subtype of acute allograft rejection, is usually associated with a significantly lower treatment response rate and a higher graft failure rate. PCAR is characterized by the presence of more than 10% of plasma cells out of all graft infiltrat...
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Wiley
2024-01-01
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| Series: | Case Reports in Transplantation |
| Online Access: | http://dx.doi.org/10.1155/2024/9226321 |
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| author | Sara Hashemi Reut Hod-Dvorai Rebecca Tong Liye Suo |
| author_facet | Sara Hashemi Reut Hod-Dvorai Rebecca Tong Liye Suo |
| author_sort | Sara Hashemi |
| collection | DOAJ |
| description | Plasma cell-rich acute rejection (PCAR), a relatively rare subtype of acute allograft rejection, is usually associated with a significantly lower treatment response rate and a higher graft failure rate. PCAR is characterized by the presence of more than 10% of plasma cells out of all graft infiltrating cells, with approximately 40%–60% of PCAR resulting in graft failure within a year. Currently, there is no gold standard for the effective treatment of PCAR. This case report demonstrates the potential treatment effect of bortezomib in PCAR. A 37-year-old woman with reflux nephropathy received a kidney transplant from a brain-dead kidney donor. The patient presented with an acute kidney injury with a serum creatinine level over 4 mg/dL 4 months after the surgery. The allograft biopsy showed acute T cell–mediated rejection (TCMR), Grade IIA, plasma cell-rich variant. There were diffuse polyclonal plasma cells infiltrating the renal parenchyma with marked tubulitis and focal endarteritis. She received a methylprednisolone pulse of 500 mg daily x3, followed by thymoglobulin (rATG) at 4.2 mg/kg. However, a repeated biopsy after 2 months showed persistent plasma cells infiltrate with increased interstitial fibrosis with tubular atrophy. Then, the patient was given one cycle of bortezomib with a total of four subcutaneous injections and continued immunosuppressants of tacrolimus, mycophenolate mofetil, and prednisone. Following the treatment, the patient’s serum creatinine level trended down to 2 mg/dL, and a second repeat biopsy after 4 months showed a significant treatment effect with complete resolution of interstitial inflammation and decreased chronicity. Bortezomib is a proteasome inhibitor that prevents cell proliferation by inducing apoptosis in plasma cells and has shown great promise as a therapeutic agent for multiple myeloma. Our case suggests that bortezomib can also be used as a potential therapeutic intervention for patients with PCAR. |
| format | Article |
| id | doaj-art-a959a024102246dda5be4b36f97b9b44 |
| institution | Kabale University |
| issn | 2090-6951 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Transplantation |
| spelling | doaj-art-a959a024102246dda5be4b36f97b9b442025-02-03T11:55:21ZengWileyCase Reports in Transplantation2090-69512024-01-01202410.1155/2024/9226321Successful Treatment of Plasma Cell-Rich Acute Rejection Using Bortezomib: A Case ReportSara Hashemi0Reut Hod-Dvorai1Rebecca Tong2Liye Suo3Division of Nephrology and TransplantationDepartment of PathologyDepartment of PathologyDepartment of PathologyPlasma cell-rich acute rejection (PCAR), a relatively rare subtype of acute allograft rejection, is usually associated with a significantly lower treatment response rate and a higher graft failure rate. PCAR is characterized by the presence of more than 10% of plasma cells out of all graft infiltrating cells, with approximately 40%–60% of PCAR resulting in graft failure within a year. Currently, there is no gold standard for the effective treatment of PCAR. This case report demonstrates the potential treatment effect of bortezomib in PCAR. A 37-year-old woman with reflux nephropathy received a kidney transplant from a brain-dead kidney donor. The patient presented with an acute kidney injury with a serum creatinine level over 4 mg/dL 4 months after the surgery. The allograft biopsy showed acute T cell–mediated rejection (TCMR), Grade IIA, plasma cell-rich variant. There were diffuse polyclonal plasma cells infiltrating the renal parenchyma with marked tubulitis and focal endarteritis. She received a methylprednisolone pulse of 500 mg daily x3, followed by thymoglobulin (rATG) at 4.2 mg/kg. However, a repeated biopsy after 2 months showed persistent plasma cells infiltrate with increased interstitial fibrosis with tubular atrophy. Then, the patient was given one cycle of bortezomib with a total of four subcutaneous injections and continued immunosuppressants of tacrolimus, mycophenolate mofetil, and prednisone. Following the treatment, the patient’s serum creatinine level trended down to 2 mg/dL, and a second repeat biopsy after 4 months showed a significant treatment effect with complete resolution of interstitial inflammation and decreased chronicity. Bortezomib is a proteasome inhibitor that prevents cell proliferation by inducing apoptosis in plasma cells and has shown great promise as a therapeutic agent for multiple myeloma. Our case suggests that bortezomib can also be used as a potential therapeutic intervention for patients with PCAR.http://dx.doi.org/10.1155/2024/9226321 |
| spellingShingle | Sara Hashemi Reut Hod-Dvorai Rebecca Tong Liye Suo Successful Treatment of Plasma Cell-Rich Acute Rejection Using Bortezomib: A Case Report Case Reports in Transplantation |
| title | Successful Treatment of Plasma Cell-Rich Acute Rejection Using Bortezomib: A Case Report |
| title_full | Successful Treatment of Plasma Cell-Rich Acute Rejection Using Bortezomib: A Case Report |
| title_fullStr | Successful Treatment of Plasma Cell-Rich Acute Rejection Using Bortezomib: A Case Report |
| title_full_unstemmed | Successful Treatment of Plasma Cell-Rich Acute Rejection Using Bortezomib: A Case Report |
| title_short | Successful Treatment of Plasma Cell-Rich Acute Rejection Using Bortezomib: A Case Report |
| title_sort | successful treatment of plasma cell rich acute rejection using bortezomib a case report |
| url | http://dx.doi.org/10.1155/2024/9226321 |
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