Antibody mediated rejection continues to be one of the most detrimental complications of kidney transplant. Multiple therapeutic strategies focused on B cell and/or HLA antibody removal are used with conflicting reports regarding efficacy. Tocilizumab (TCZ), an IL-6 inhibitor, has shown promising results in downregulating humoral immunity in patients with chronic antibody mediated rejection (AMR). Its efficacy has not been examined in the treatment of acute AMR. We present the case of 5 patients with acute AMR who received Tocilizumab therapy between Oct 2016 – Jun 2017. All patients were sensitized with history of prior transplant, rejection and/or pre-transplant cPRA of 100%, and had evidence of high DSA MFIs at the time of biopsy. Patients received treatment with IV Solumedrol, IVIG and increasing tacrolimus trough target to 10-12 ng/ml. 1 patient received rituximab, 2 patients received Thymoglobuin and 1 patient received a dose of eculizuamb for TMA like features on kidney biopsy. TCZ 8 mg/kg monthly infusion therapy was started during treatment for acute rejection episode and continued for a duration of 3-6 months. Renal function improved in all 5 patients. DSAs decreased significantly in 4 patients and remained stable in the 5^th. Tocilizumab therapy was discontinued in 3 patients due to complications including CMV disease and severe allergic reaction. Severe combined cellular and AMR occurred 7 months post discontinuation in one patient.

The addition of TCZ to acute AMR treatment strategy appears to be effective and needs further validation.

CITATION INFORMATION: Venkatachalam K., Reem D., Andrew M., Delos Santos R., Alhamad T. Efficacy and Safety of Tocilizumab in Treatment of Acute Antibody Mediated Rejection Am J Transplant. 2017;17 (suppl 3).

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