Long Term Outcomes Using Tocilizumab For The Treatment Of Chronic Antibody Mediated Rejection

J. Choi¹, E. Huang¹, O. Aubert², A. Vo¹, A. Peng¹, R. Najjar¹, S. Sethi¹, N. Ammerman¹, K. Lim¹, D. Puliyanda¹, A. Loupy², S. Jordan¹

¹Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, ²Paris Translational Center for Organ Transplantation, Paris, France

Meeting: 2019 American Transplant Congress

Abstract number: 322

Keywords: Antibodies, Highly-sensitized, Kidney transplantation, Rejection

Session Information

Session Name: Concurrent Session: Kidney Chronic Antibody Mediated Rejection

Session Type: Concurrent Session

Date: Monday, June 3, 2019

Session Time: 4:30pm-6:00pm

Presentation Time: 5:30pm-5:42pm

Location: Ballroom B

*Purpose: Limited options exist for the treatment of kidney allograft rejection and preservation of allograft function. We reported our experience with anti-IL-6R (tocilizumab, TCZ) as a treatment for chronic antibody mediated rejection (CABMR) (AJT 2017; 17: 2381-2389). CABMR is a complication of pre-existing donor specific antibodies (preDSAs) (Type 1) or de novo (dnDSAs) (Type 2). Patients who develop CABMR+TG have a poor prognosis with graft failure & return to dialysis. Here we report on our extended experience with TCZ for CABMR+TG

*Methods: Since 4/2011 we identified 73 patients including those with active ABMR, CABMR, and DSA+. TCZ treatment was pursued after patients failed high-dose IVIG, rituximab, +/- PLEX, +/- Eculizumab. Briefly, after diagnosis of ABMR, patients received TCZ 4-8mg/kg monthly for 3-37 doses & were followed up to 7 years from TCZ initiation. Patients were monitored for DSAs using Luminex, AT1Rab (ELISA), renal function, and patient/graft survival.

*Results: Baseline eGFR at TCZ initiation was 50ml/min. Change in eGFR over 7 years after initiation of TCZ was -4.0 ml/min/1.73 m² (95% CI: -5.9 to -2.1). The mean time from transplant to TCZ treatment was 5.4±4.4 years & mean time from CABMR diagnosis to treatment was 1.4+1.6 years. Immunodominant (iDSA) levels tended to decrease after therapy but not statistically significant. Two deaths in the TCZ group. 14 of 73 (19%) patients lost their graft over a seven year period.

*Conclusions: CABMR & TG patients treated with TCZ after failing existing treatment continue to show long term stabilization of renal function and graft survival in a population where poorer outcomes would be expected.

To cite this abstract in AMA style:

Choi J, Huang E, Aubert O, Vo A, Peng A, Najjar R, Sethi S, Ammerman N, Lim K, Puliyanda D, Loupy A, Jordan S. Long Term Outcomes Using Tocilizumab For The Treatment Of Chronic Antibody Mediated Rejection [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/long-term-outcomes-using-tocilizumab-for-the-treatment-of-chronic-antibody-mediated-rejection/. Accessed November 22, 2024.

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