Combined use of Carfilzomib and plasmapheresis in antibody-mediated liver transplant rejection

Area of Science:

• Transplantation Medicine
• Immunology
• Pharmacology

Background:

• Antibody-mediated rejection (AMR) is a significant clinical challenge in liver transplant recipients.
• Current treatment guidelines for AMR often involve therapeutic plasma exchange (TPE) and immunosuppression but lack standardized protocols.
• Refractory AMR cases require exploration of novel therapeutic combinations.

Purpose of the Study:

• To evaluate the efficacy of Carfilzomib in combination with TPE for treating liver transplant recipients with AMR.
• To compare outcomes in patients with early versus late AMR treated with Carfilzomib and TPE.
• To identify factors influencing treatment response in AMR.

Main Methods:

• Case report of two liver transplant patients with AMR refractory to standard treatments.
• Treatment involved a combination of Carfilzomib and TPE.
• Clinical outcomes, liver function tests (LFTs), bilirubin levels, and donor-specific antibody (DSA) levels were monitored.

Main Results:

• Patient 1, with early AMR, showed significant clinical improvement, normalized LFTs and bilirubin, and reduced DSA levels after Carfilzomib and TPE.
• Patient 2, with late AMR and complicating factors, had minimal clinical improvement despite marginal DSA reduction, ultimately requiring re-transplantation.
• Treatment response appeared dependent on the timing of AMR and presence of other clinical issues.

Conclusions:

• Carfilzomib and TPE combination therapy may improve outcomes in select liver transplant patients with early AMR.
• Late AMR, chronic rejection, and medication adherence issues can complicate treatment response.
• Personalized treatment strategies are crucial for managing AMR in liver transplant patients.