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A Rat Orthotopic Renal Transplantation Model for Renal Allograft Rejection
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Thinking Outside the Box: Managing Refractory Antibody-Mediated Rejection Based on Injury-Related Phenotype to

Rajeev Sharma1, Abhinav Seth1, Briana Sowers1

  • 1Transplant Surgery, West Virginia University, Morgantown, WV, USA.

Journal of Intensive Care Medicine
|January 21, 2026
PubMed

Insights

Tocilizumab, an interleukin-6 (IL-6) receptor monoclonal antibody, shows promise for treating chronic active antibody-mediated rejection in kidney transplant patients. This approach may be particularly effective when IL-6 levels are elevated, improving graft function.

Area of Science:

  • Nephrology
  • Immunology
  • Transplantation

Background:

  • End-stage renal disease (ESRD) due to diabetes and hypertension often necessitates kidney transplantation.
  • Chronic active antibody-mediated rejection (CAAMR) is a significant cause of renal allograft failure.
  • Standard treatments for CAAMR, including immunotherapy, are not always effective.

Purpose of the Study:

  • To report a case of refractory CAAMR following renal transplantation.
  • To investigate the efficacy of IL-6 blockade in a patient with elevated IL-6 levels and CAAMR.
  • To highlight a potential novel therapeutic strategy for difficult-to-treat CAAMR.

Main Methods:

  • A patient with ESRD, diabetes, and hypertension received a renal transplant.
  • The patient developed refractory CAAMR despite standard immunosuppressive therapy.
  • Treatment with tocilizumab, an IL-6 receptor antagonist, was initiated due to elevated IL-6 levels.

Main Results:

  • Tocilizumab treatment led to a significant decrease in serum creatinine levels.
  • Renal allograft injury stabilized following tocilizumab administration.
  • Persistent donor-specific antibodies were noted, but graft function improved.

Conclusions:

  • Interleukin-6 (IL-6) blockade with tocilizumab may be a viable treatment option for refractory CAAMR.
  • This approach is particularly relevant in cases where IL-6-mediated injury is suspected.
  • Targeting IL-6 offers a potential new avenue for managing challenging kidney transplant rejection scenarios.
Keywords:
IL6kidney transplantationtocilizumab

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