Novel Desensitization Kidney Transplantation

Inclusion Criteria:

• Highly sensitized patient cPRA 99-100% AND actively listed for kidneytransplantation at the kidney transplantation Program at University fo Chicago

• Ebstein Barr Virus (EBV) Immunoglobulins (IgG) seropositive

• No active systemic infection

• No allergy to proteasome inhibitors (Bortezomib), or to belatacept

• No known malignancy in the previous 2 years except for non-melanomatous skin cancer

• Female who agrees to practice 2 effective methods of contraception through 3 monthsafter the last dose of Bortezomib

• Patient vaccinated against hepatitis B virus with positive level of HBsAb

• Patients fully vaccinated against Coronavirus Disease 2019 at least 2 weeks prior tothe start of the 1st cycle.

• Actively listed for kidney transplant at the Transplant Institute at University ofChicago

Exclusion Criteria:

• Patient with significant neuropathy by the Common Terminology Criteria for AdverseEvents (CTCAE) criteria within 14 days before enrollment (Grades 3-4 or Grade 2 withpain)

• Myocardial infarction within 6 months of enrollment or has Heart Failure in acutedialysis quality initiative (ADQI) ESRD classification system Class 2 nonrestrictive (2NR) or greater, uncontrolled angina, severe uncontrolled ventriculararrhythmias, or ECG evidence of acute ischemia or active conduction systemabnormalities

• Patient who received other investigational drugs within 14 days prior to initiationof study treatment

• Receipt of a live vaccine within 4 weeks prior to initiation of study treatment

• Evidence of severe liver disease by history or physical exam or with abnormal liverprofile ( > 1.5 times upper limit of normal within 30 days of consent)

• Female who is breast feeding or pregnant

• Untreated latent tuberculosis

• History of Post Transplant Lymphoproliferative Disease (PTLD)

• Patient still carrying previous kidney transplant.