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Journal of Immunology Research
Volume 2017, Article ID 6872046, 9 pages
Clinical Study

Treatment of Antibody-Mediated Renal Allograft Rejection: Improving Step by Step

1Tissue Typing Laboratory, Charité Universitätsmedizin Berlin, Berlin, Germany
2Department of Nephrology, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
3University Tissue Bank, Institute of Transfusion Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany

Correspondence should be addressed to Nils Lachmann; ed.etirahc@nnamhcal.slin

Received 23 September 2016; Revised 17 December 2016; Accepted 15 January 2017; Published 31 January 2017

Academic Editor: Mepur H. Ravindranath

Copyright © 2017 Nils Lachmann et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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.