Emerging strategies for antibody-mediated rejection

Area of Science:

• Nephrology
• Transplantation Immunology
• Pharmacology

Background:

• Antibody-mediated rejection (AMR) is the principal cause of kidney graft failure.
• Limited therapeutic options currently exist for managing AMR.
• This review focuses on established and emerging treatments for AMR.

Purpose of the Study:

• To review current therapeutic strategies for antibody-mediated rejection (AMR) in kidney transplantation.
• To describe novel approaches under development for managing AMR.
• To provide an overview of available and investigational treatments for AMR.

Main Methods:

• Literature review of available therapeutics for AMR.
• Description of novel approaches currently in development for AMR.
• Analysis of emerging treatment strategies for acute and chronic AMR.

Main Results:

• Imlifidase, an IgG-cleaving agent, shows potential as an alternative to apheresis.
• New complement inhibitors are being developed to prevent acute kidney damage post-antibody removal.
• Plasma cell depletion therapies (daratumumab, felzartamab) and IL-6 inhibition are being investigated for chronic AMR.

Conclusions:

• Effective AMR treatment necessitates a multidrug approach targeting antibody removal, rebound prevention, and effector blockade.
• Strategies for chronic AMR focus on reducing inflammation induced by donor-specific antibodies.
• Ongoing research is vital to establish safety and efficacy of novel multidrug regimens in AMR management.