Telitacicept treatment for active antibody-mediated rejection after kidney transplantation: a case series

Antibody-mediated rejection (AMR) is a leading cause of kidney transplant failure with limited effective therapies, while telitacicept (a TACI-Fc fusion protein targeting BAFF/APRIL) may be a promising option. We retrospectively analyzed the data regarding eight pateints with biopsy-confirmed active AMR (aAMR) observed in the period June 2023-December 2024, who received subcutaneous telitacicept 80 mg twice weekly (≥24 weeks) and recorded as primary outcome serum creatinine (Scr) and estimated Glomerular Filtration Rate (eGFR) changes at 3/6/9/12 months, and as secondary outcomes the evolution of proteinuria and the onset of adverse events. The series (4 men, 4 women) had a median interval of 6-15 years from transplantation to treatment; at month 0 (baseline), mean Scr was 182.63 ± 37.91 μmol/L and baseline eGFR was 44.9 ± 17.65 mL/min/1.73 m2. Over the period of study, seven of eight patients showed relative stability of sCr/eGFR, while one recipient experienced progressive graft dysfunction. Two had improved proteinuria; adverse events were mild (1 varicella, 1 herpes zoster, responsive to treatment), with one treatment failure due to recurrent infections. In this small case series, telitacicept use was temporally associated with renal function stability in most recipients with aAMR and displayed a good safety profile. These observations are hypothesis-generating and warrant confirmation in larger controlled studies.