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. 2023 Oct;42(10):1353-1357.
doi: 10.1016/j.healun.2023.05.012. Epub 2023 Jun 1.

Tocilizumab for antibody-mediated rejection treatment in lung transplantation

Spenser E January  1 , Keith A Fester  2 , Laura P Halverson  3 , Chad A Witt  3 , Derek E Byers  3 , Rodrigo Vazquez-Guillamet  3 , Jennifer Alexander-Brett  3 , Laneshia K Tague  3 , Daniel Kreisel  4 , Andrew Gelman  4 , Varun Puri  4 , Ruben Nava Bahena  4 , Tsuyoshi Takahashi  4 , Ramsey R Hachem  3 , Hrishikesh S Kulkarni  3
Affiliations

Tocilizumab for antibody-mediated rejection treatment in lung transplantation

Spenser E January et al. J Heart Lung Transplant. 2023 Oct.

Abstract

Tocilizumab (TCZ), an IL-6 inhibitor, has shown promise in the treatment of donor-specific antibodies (DSA) and chronic antibody-mediated rejection (AMR) in renal transplant recipients. However, its use in lung transplantation has not been described. This retrospective case-control study compared AMR treatments containing TCZ in 9 bilateral lung transplant recipients to 18 patients treated for AMR without TCZ. Treatment with TCZ resulted in more clearance of DSA, lower recurrence of DSA, lower incidence of new DSA, and lower rates of graft failure when compared to those treated for AMR without TCZ. The incidence of infusion reactions, elevation in transaminases, and infections were similar between the 2 groups. These data support a role for TCZ in pulmonary AMR and establish preliminary evidence to design a randomized controlled trial of IL-6 inhibition for the management of AMR.

Keywords: antibody-mediated rejection; donor-specific antibodies; interleukin-6 inhibition; lung transplantation; tocilizumab.

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Figures

Figure 1.
Figure 1.
CONSORT flow diagram of study exclusions (Panel A), outcomes of donor-specific antibodies up to 12 months after AMR treatment completion (Panel B), average FEV1 trend from the start of AMR treatment up to 12 months after AMR treatment completion (Panel C), Kaplan-Meier graph of graft failure in the 12 months after AMR treatment completion, P=0.213 via log-rank test (Panel D).
See this image and copyright information in PMC

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