Eculizumab in Renal Transplantation: A 2017 Update

Despite ongoing progress in renal transplantation, there are still emerging challenges in this field, including consequences of ischemia-reperfusion injury (IRI), pre-existing and produced de novo anti-HLA donor-specific antibodies (DSA), and acute/chronic humoral rejection (AMR), as well as the recurrence of atypical hemolytic-uremic syndrome (aHUS) in genetically predisposed patients. All these conditions are related to the prominent role of the complement system and are deleterious to the fate of the renal graft. Eculizumab, a humanized monoclonal antibody directed against the complement C5a component, is currently being used in renal transplantation and was evaluated in several clinical trials to minimize the consequences of IRI, prevent or treat relapsing or de novo aHUS, and to prevent and cure humoral rejection in patients at high immunological risk. There are remaining issues in terms of defining precise indications, dosing, monitoring, and optimal duration of the therapy with this drug; however, eculizumab is an emerging drug in renal transplantation.