Antibody-Mediated Rejection - Treatment Standard
A treatment-standard review concludes that most conventional therapies for antibody-mediated kidney transplant rejection lack robust evidence, while newer approaches such as CD38 antibodies and complement inhibition show the most promise in ongoing trials.
Background
Antibody-mediated rejection (AMR) remains a major cause of kidney allograft failure, yet more than 25 years after its recognition its treatment is unstandardized and no therapy has gained robust regulatory approval, with most well-designed trials yielding negative results.
Key findings
The authors conclude that steroids, rituximab, bortezomib, and IL-6 antagonists lack sufficiently robust evidence. For early AMR, immunoadsorption or plasmapheresis with optional high-dose IVIG may be considered, and complement inhibition may be an option in severe early AMR. Recent phase 2 data on CD38 antibodies (felzartamab) suggest targeting endothelial inflammation is a promising approach.
Clinical implications
Current practice relies on low-evidence, phenotype-tailored options; ongoing phase 2 trials (prolonged IVIG, efgartigimod, fostamatinib, BIVV020) and phase 3 trials of tocilizumab and felzartamab offer hope for the first robustly approved AMR therapies.
Category
Transplant
Source
Nephrology Dialysis Transplantation
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