Antibody Mediated Rejection in Heart Transplantation
Antibody Mediated Rejection in Heart Transplantation
Antibody Mediated Rejection in Heart Transplantation
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Refractory Antibodies:<br />
Role of Bortezomib<br />
Cedar S<strong>in</strong>ai experience<br />
• 6 patients with cPRA ≥ 50% despite<br />
PP/IV Ig/ritux<br />
• Side effects<br />
– UTI, pneumonia, catheter<br />
<strong>in</strong>fection, C difficile<br />
– Neuropathy: responded to<br />
reduction <strong>in</strong> dose<br />
• Outcomes<br />
– cPRA ê� from 62% to 35%<br />
– 5 with fall <strong>in</strong> cPRA and<br />
successfully transplanted<br />
– 1 with no Δ <strong>in</strong> cPRA and died<br />
from sepsis after cycle #2<br />
– 1 died post-OHT from sepsis<br />
cPRA ≥ 50% after IV Ig/ritux<br />
protocol<br />
Days 1, 4,<br />
8, 11<br />
Day 25<br />
Repeat 2-wk cycle if<br />
cPRA ≥ 50%<br />
Plasmapheresis<br />
Bortezomib<br />
1.3 mg/m 2<br />
Check PRA<br />
Patel et al J <strong>Heart</strong> and Lung Transp 2011; 30:1320
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