Skip to main content
Journal cover image

Long term tolerability and clinical outcomes associated with tocilizumab in the treatment of refractory antibody mediated rejection (AMR) in pediatric renal transplant recipients.

Publication ,  Conference
Pearl, M; Weng, PL; Chen, L; Dokras, A; Pizzo, H; Garrison, J; Butler, C; Zhang, J; Reed, EF; Kim, IK; Choi, J; Haas, M; Zhang, X; Vo, A ...
Published in: Clin Transplant
August 2022

BACKGROUND: Treatment options for antibody-mediated rejection (AMR) are limited. Recent studies have shown that inhibition of interleukin-6 (IL-6)/interleukin-6 receptor (IL-6R) signaling can reduce inflammation and slow AMR progression. METHODS: We report our experience using monthly tocilizumab (anti-IL6R) in 25 pediatric renal transplant recipients with AMR, refractory to IVIg/Rituximab. From January 2013 to June 2019, a median (IQR) of 12 (6.019.0) doses of tocilizumab were given per patient. Serial assessments of renal function, biopsy findings, and HLA DSA (by immunodominant HLA DSA [iDSA] and relative intensity score [RIS]) were performed. RESULTS: Median (IQR) time from transplant to AMR was 41.4 (24.367.7) months, and time from AMR to first tocilizumab was 10.6 (8.317.6) months. At median (IQR) follow up of 15.8 (8.435.7) months post-tocilizumab initiation, renal function was stable except for 1 allograft loss. There was no significant decrease in iDSA or RIS. Follow up biopsies showed reduction in peritubular capillaritis (p = .015) and C4d scoring (p = .009). The most frequent adverse events were cytopenias. CONCLUSIONS: Tocilizumab in pediatric patients with refractory AMR was well tolerated and appeared to stabilize renal function. The utility of tocilizumab in the treatment of AMR in this population should be further explored.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Clin Transplant

DOI

EISSN

1399-0012

Publication Date

August 2022

Volume

36

Issue

8

Start / End Page

e14734

Location

Denmark

Related Subject Headings

  • Surgery
  • Kidney Transplantation
  • Kidney
  • Isoantibodies
  • Humans
  • HLA Antigens
  • Graft Survival
  • Graft Rejection
  • Child
  • Biopsy
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Pearl, M., Weng, P. L., Chen, L., Dokras, A., Pizzo, H., Garrison, J., … Puliyanda, D. (2022). Long term tolerability and clinical outcomes associated with tocilizumab in the treatment of refractory antibody mediated rejection (AMR) in pediatric renal transplant recipients. In Clin Transplant (Vol. 36, p. e14734). Denmark. https://doi.org/10.1111/ctr.14734
Pearl, Meghan, Patricia L. Weng, Lucia Chen, Aditi Dokras, Helen Pizzo, Jonathan Garrison, Carrie Butler, et al. “Long term tolerability and clinical outcomes associated with tocilizumab in the treatment of refractory antibody mediated rejection (AMR) in pediatric renal transplant recipients.” In Clin Transplant, 36:e14734, 2022. https://doi.org/10.1111/ctr.14734.
Pearl M, Weng PL, Chen L, Dokras A, Pizzo H, Garrison J, Butler C, Zhang J, Reed EF, Kim IK, Choi J, Haas M, Zhang X, Vo A, Chambers ET, Ettenger R, Jordan S, Puliyanda D. Long term tolerability and clinical outcomes associated with tocilizumab in the treatment of refractory antibody mediated rejection (AMR) in pediatric renal transplant recipients. Clin Transplant. 2022. p. e14734.
Journal cover image

Published In

Clin Transplant

DOI

EISSN

1399-0012

Publication Date

August 2022

Volume

36

Issue

8

Start / End Page

e14734

Location

Denmark

Related Subject Headings

  • Surgery
  • Kidney Transplantation
  • Kidney
  • Isoantibodies
  • Humans
  • HLA Antigens
  • Graft Survival
  • Graft Rejection
  • Child
  • Biopsy