Tocilizumab and Desensitization in Kidney Transplant Candidates: Personal Experience and Literature Review.
anti-HLA alloantibody
clazakizumab
desensitization
kidney transplantation
tocilizumab
Journal
Journal of clinical medicine
ISSN: 2077-0383
Titre abrégé: J Clin Med
Pays: Switzerland
ID NLM: 101606588
Informations de publication
Date de publication:
24 Sep 2021
24 Sep 2021
Historique:
received:
30
08
2021
revised:
18
09
2021
accepted:
20
09
2021
entrez:
13
10
2021
pubmed:
14
10
2021
medline:
14
10
2021
Statut:
epublish
Résumé
Desensitization (DES) allows kidney transplantation for highly HLA-sensitized subjects. Due to the central role of IL-6 in the immunological response, tocilizumab may improve DES efficacy. Thus, we conducted a PubMed systematic review using the MeSH terms tocilizumab, interleukin-6, kidney transplantation, and desensitization. Tocilizumab (TCZ) was first studied for DES as the second-line treatment after failure of a standard DES protocol (SP) (apheresis, rituximab +/- IVIg). Although TCZ (as a monotherapy) attenuated anti-HLA antibody rates, it did not permit transplantation. However, lymphocyte immuno-phenotyping has shown that TCZ hinders B-cell maturation and thus could improve the long-term efficacy of DES by limiting anti-HLA rebound and so avoid antibody-mediated rejection. This hypothesis is supported by a recent study where clazakizumab, a monoclonal antibody directed against IL-6, was continued after kidney transplantation in association with an SP. Nine out of ten patients were then eligible for transplantation, and there were no donor-specific antibodies at 6 months post-transplantation. In association with an SP, tocilizumab does not seem to significantly improve kidney-allograft access (short-term efficacy) vs. a SP only. However, it could improve the long-term prognosis of HLA-incompatible transplantation by hindering B-cell maturation and, thereby, avoiding donor-specific antibody rebounds post-transplantation.
Identifiants
pubmed: 34640377
pii: jcm10194359
doi: 10.3390/jcm10194359
pmc: PMC8509506
pii:
doi:
Types de publication
Journal Article
Review
Langues
eng
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