Tocilizumab-Based Treatment of Microvascular Inflammation in Kidney Transplant Recipients: A Retrospective Study
Résumé
Chronic-active antibody mediated rejection (caAMR) is the leading causes of long-term kidney graft failure. Tocilizumab (TCZ), an anti-IL-6 receptor antibody, has been suggested as a treatment, but data are conflicting. We retrospectively studied consecutive adult kidney transplant recipients with caAMR or microvascular inflammation (MVI) without Donor-Specific Antibodies (DSA) and without C4d deposition (MVI + DSA-C4d-), who received TCZ as first-line therapy in two European centers. Estimated glomerular filtration rate (eGFR) and DSA were assessed one-year before and after TCZ initiation. The study included 64 patients who received TCZ between July 2018 and September 2023. The eGFR trajectory significantly decreased after TCZ treatment (-1.2 ± 0.2 vs. 0.03 ± 0.2 mL/ min/1.73 m 2 /month pre-vs. post-TCZ, respectively; p = 0.001). The percentage of patients with DSA decreased from 63.9% to 38.9% (p < 0.001), and the average MFI decreased from 9,537 to 7,250 (p = 0.001). In multivariate analysis, younger age (OR = 0.95, p = 0.02), MVI + DSA-C4d-phenotype (OR = 5.2, p = 0.01), and lower chronic glomerulopathy score (OR = 4.5, p = 0.02) were associated with TCZ response (trajectory ≥0 after TCZ). Patient survival was 98.4%, and graft survival was 93.7% at
Mots clés
- g, glomerulitis
- UACR, Urine Albumin-To-Creatinine Ratio kidney transplantation, tocilizumab, microvascular inflammation, donor-specific antibody, chronicactive antibody-mediated rejection
- TCZ, Tocilizumab
- RCT, Randomize Clinical Trial
- Ptc, Peritubular capillaritis
- MFI, Mean fluorescence Intensity
- KT, Kidney Transplantation
- IL-6R, Interleukin-6 Receptor
- IL-6, Interleukin-6
- iDSA, immunodominant Donor-Specific Antibody
- HLA, Human Leukocyte Antigen
- eGFR, estimated Glomerular Filtration Rate
- DSA, Donor-Specific Antibody
- CMV, Cytomegalovirus
- CLZ, Clazakizumab
- CKD-Epi, Chronic Kidney Disease-Epidemiology collaboration equation
- cg, Chronic Glomerulopathy
- caAMR, chronic active AMR
- AMR, Antibody-Mediated Rejection
- AMR, Antibody-Mediated Rejection caAMR, chronic active AMR cg, Chronic Glomerulopathy CKD-Epi, Chronic Kidney Disease-Epidemiology collaboration equation CLZ, Clazakizumab CMV, Cytomegalovirus DSA, Donor-Specific Antibody eGFR, estimated Glomerular Filtration Rate g, glomerulitis HLA, Human Leukocyte Antigen iDSA, immunodominant Donor-Specific Antibody IL-6, Interleukin-6 IL-6R, Interleukin-6 Receptor KT, Kidney Transplantation MFI, Mean fluorescence Intensity Ptc, Peritubular capillaritis RCT, Randomize Clinical Trial TCZ, Tocilizumab UACR, Urine Albumin-To-Creatinine Ratio kidney transplantation, tocilizumab, microvascular inflammation, donor-specific antibody, chronicactive antibody-mediated rejection
Domaines
| Origine | Fichiers produits par l'(les) auteur(s) |
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