Kidney research and clinical practice · 2025
Effectiveness and safety of tocilizumab treatment for chronic active antibody-mediated rejection in kidney transplant recipients.
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Lee Ha-Eun, Park Hyeran, Lee Hanbi, Choi Yeong Jin, Oh Eun-Jee, Chung Byung Ha
Аннотация
BACKGROUND: Chronic active antibody-mediated rejection (cABMR) is a leading cause of allograft failure in kidney transplantation (KT) recipients. However, no effective treatment has been established. This study investigated the effectiveness and safety of tocilizumab (TCZ), an anti-interleukin-6 receptor antibody, in delaying cABMR progression in KT recipients.
METHODS: We included 18 KT recipients with cABMR treated with TCZ (8 mg/kg/mo for 6 months). The primary outcome was allograft survival. Secondary outcomes included changes in the estimated glomerular filtration rate (eGFR), proteinuria, mean fluorescence intensity (MFI) of anti-human leukocyte antigen (HLA) antibodies, and adverse events (AEs).
RESULTS: During a mean follow-up of 18.2 months, allograft failure occurred in eight patients (44.4%). Baseline eGFR was the only significant predictor of allograft failure (hazard ratio, 0.854; 95% confidence interval, 0.791-0.959). In most patients, TCZ reduced the MFI of anti-HLA antibodies. The decline in eGFR was attenuated after TCZ treatment (ΔeGFR from -11.5 ± 10.7 to -2.9 ± 6.6 mL/min/1.73 m2, p = 0.03). Proteinuria decreased from 1.9 ± 2.2 g/g to 1.3 ± 1.4 g/g, although the change was not statistically significant. AEs included infections (n = 5), hypogammaglobulinemia (n = 6), and leukopenia (n = 2), with TCZ discontinued in one case of severe leukopenia. The results of the subgroup analysis suggested favorable outcomes in the preserved eGFR group (≥25.5 mL/min/1.73 m2) compared with the reduced eGFR group (<25.5 mL/min/1.73 m2).
CONCLUSION: TCZ should be selectively used in patients with preserved allograft function, considering the limited evidence, potential risks, and substantial costs.
METHODS: We included 18 KT recipients with cABMR treated with TCZ (8 mg/kg/mo for 6 months). The primary outcome was allograft survival. Secondary outcomes included changes in the estimated glomerular filtration rate (eGFR), proteinuria, mean fluorescence intensity (MFI) of anti-human leukocyte antigen (HLA) antibodies, and adverse events (AEs).
RESULTS: During a mean follow-up of 18.2 months, allograft failure occurred in eight patients (44.4%). Baseline eGFR was the only significant predictor of allograft failure (hazard ratio, 0.854; 95% confidence interval, 0.791-0.959). In most patients, TCZ reduced the MFI of anti-HLA antibodies. The decline in eGFR was attenuated after TCZ treatment (ΔeGFR from -11.5 ± 10.7 to -2.9 ± 6.6 mL/min/1.73 m2, p = 0.03). Proteinuria decreased from 1.9 ± 2.2 g/g to 1.3 ± 1.4 g/g, although the change was not statistically significant. AEs included infections (n = 5), hypogammaglobulinemia (n = 6), and leukopenia (n = 2), with TCZ discontinued in one case of severe leukopenia. The results of the subgroup analysis suggested favorable outcomes in the preserved eGFR group (≥25.5 mL/min/1.73 m2) compared with the reduced eGFR group (<25.5 mL/min/1.73 m2).
CONCLUSION: TCZ should be selectively used in patients with preserved allograft function, considering the limited evidence, potential risks, and substantial costs.