Tocilizumab for the treatment of chronic antibody mediated rejection in kidney transplant recipients. Issue 1 (7th December 2022)

• Record Type: Journal Article
• Authors: Khairallah, Pascale; Robbins‐Juarez, Shelief; Patel, Shefali; Shah, Vaqar; Toma, Katherine; Fernandez, Hilda; Dube, Geoffrey K.; King, Kristen; Mohan, Sumit; Husain, Syed Ali; Morris, Heather; Crew, Russell John
• Is Part Of: Clinical transplantation. Volume 37:Issue 1(2023)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2022-12-07
• Subjects: chronic active antibody mediated rejection (CAAMR) -- donor specific antibodies -- interleukin‐6 (IL‐6) -- kidney transplantation; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ctr.14853
• Languages: English
• ISSNs: 0902-0063

Abstract

Abstract: Background: Chronic active antibody‐mediated rejection (CAAMR) constitutes a dominant form of late allograft failure. Several treatment strategies directed at CAAMR have been attempted but proven ineffective at delaying kidney function decline or reducing donor‐specific antibodies (DSA). We describe our single‐center experience using tocilizumab in patients with CAAMR. Methods: This is a retrospective analysis using electronic medical records. 38 kidney transplant recipients at Columbia University Irving Medical Center who had been prescribed tocilizumab and followed for at least 3 months between August 2013 through December 2019 were included. Results: Tocilizumab use was associated with a decrease in the rate of estimated glomerular filtration rate (eGFR) decline in the 6 months following treatment initiation as compared to the 3 months before tocilizumab was initiated (difference between slopes before and after initiation of treatment = 2.6 mL/min/1.73 m 2 (SE = .8, p = .002) per month for up to 6 months following Tocilizumab initiation). Allograft biopsies showed significant improvement in interstitial inflammation scores (score 1(0, 1) to 0 (0, 1), p = .03) while other histologic scores remained stable. There was no significant change in proteinuria or DSA titers post‐treatment with tocilizumab. Conclusions: Treatment of CAAMR with tocilizumab was associated with a decrease in the rate of eGFR decline and a reduction in interstitial inflammation scores in patients with CAAMR.