Early effects of first‐line treatment with anti‐interleukin‐6 receptor antibody tocilizumab for chronic active antibody‐mediated rejection in kidney transplantation

• DOI: 10.1111/ctr.13908
• Publication Date: 2020-05-16T13:10:47Z
• Authors: Antonio Lavacca; Roberto Presta; Chiara Gai; Alberto Mella; Ester Gallo; Giovanni Camussi; Isabella Abbasciano; Antonella Barreca; Cristiana Caorsi; Fabrizio Fop; Maria Messina; Maura Rossetti; Luigi Biancone
• Keywords: Tocilizumab

Chronic active antibody-mediated rejection (cAMR) is a major determinant of late allograft failure. Rituximab/immunoglobulins (IVIg) + plasma exchange (PLEX) showed controversial results in cAMR treatment. Tocilizumab (TCZ), humanized anti-interleukin 6 receptor antibody, has been recently used as rescue therapy patients non-responsive to rituximab/IVIg/PLEX with favorable outcomes. Whether TCZ acts "per se" or requires priming effect from previous treatments currently unknown.Fifteen were treated first-line and followed for median time 20.7 months.Despite the majority experiencing advanced transplant glomerulopathy (TG) at diagnosis (60% cg3), glomerular filtration rate proteinuria stabilized during follow-up, significant reduction donor-specific antibodies. Protocol biopsies after months demonstrated amelioration microvascular inflammation no TG, C4d deposition, IF/TA progression. Gene-expression immunofluorescence analysis upregulation three genes (TJP-1, AKR1C3, CASK) involved podocyte, mesangial, tubular restoration.Tocilizumab adopted approach was associated early serological histological improvements functional stabilization even suggesting role use alone avoidance unnecessary immunosuppressants.