{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T01:36:50Z","timestamp":1775871410725,"version":"3.50.1"},"reference-count":51,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2020,6,16]],"date-time":"2020-06-16T00:00:00Z","timestamp":1592265600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100006692","name":"Universit\u00e0 degli Studi di Torino","doi-asserted-by":"publisher","award":["CAMGAUTO14"],"award-info":[{"award-number":["CAMGAUTO14"]}],"id":[{"id":"10.13039\/501100006692","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Chronic active antibody\u2010mediated rejection (cAMR) is a major determinant of late allograft failure. Rituximab\/immunoglobulins (IVIg) + plasma exchange (PLEX) showed controversial results in cAMR treatment. Tocilizumab (TCZ), a humanized anti\u2010interleukin 6 receptor antibody, has been recently used as rescue therapy in patients non\u2010responsive to rituximab\/IVIg\/PLEX with favorable outcomes. Whether TCZ acts \u201cper se\u201d or requires a priming effect from previous treatments is currently unknown.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Fifteen patients with cAMR were treated with TCZ as a first\u2010line therapy and followed for a median time of 20.7\u00a0months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Despite the majority of patients experiencing advanced transplant glomerulopathy (TG) at diagnosis (60% with cg3), glomerular filtration rate and proteinuria stabilized during the follow\u2010up, with a significant reduction in donor\u2010specific antibodies. Protocol biopsies after 6\u00a0months demonstrated significant amelioration of microvascular inflammation and no TG, C4d deposition, or IF\/TA progression. Gene\u2010expression and immunofluorescence analysis showed upregulation of three genes (TJP\u20101, AKR1C3, and CASK) involved in podocyte, mesangial, and tubular restoration.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Tocilizumab adopted as a first\u2010line approach in cAMR was associated with early serological and histological improvements and functional stabilization even in advanced TG, suggesting a role for the use of TCZ alone with the avoidance of unnecessary previous immunosuppressants.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.13908","type":"journal-article","created":{"date-parts":[[2020,5,16]],"date-time":"2020-05-16T13:10:47Z","timestamp":1589634647000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":70,"title":["Early effects of first\u2010line treatment with anti\u2010interleukin\u20106 receptor antibody tocilizumab for chronic active antibody\u2010mediated rejection in kidney transplantation"],"prefix":"10.1111","volume":"34","author":[{"given":"Antonio","family":"Lavacca","sequence":"first","affiliation":[{"name":"Renal Transplant Center \u201cA. Vercellone\u201d, Nephrology, Dialysis and Renal Transplant Division Department of Medical Sciences \u201cCitt\u00e0 della Salute e della Scienza\u201d Hospital University of Turin Turin Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Presta","sequence":"additional","affiliation":[{"name":"Renal Transplant Center \u201cA. Vercellone\u201d, Nephrology, Dialysis and Renal Transplant Division Department of Medical Sciences \u201cCitt\u00e0 della Salute e della Scienza\u201d Hospital University of Turin Turin Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiara","family":"Gai","sequence":"additional","affiliation":[{"name":"Stem Cell Laboratory Department of Medical Sciences University of Turin Turin Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Mella","sequence":"additional","affiliation":[{"name":"Renal Transplant Center \u201cA. Vercellone\u201d, Nephrology, Dialysis and Renal Transplant Division Department of Medical Sciences \u201cCitt\u00e0 della Salute e della Scienza\u201d Hospital University of Turin Turin Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ester","family":"Gallo","sequence":"additional","affiliation":[{"name":"Renal Transplant Center \u201cA. Vercellone\u201d, Nephrology, Dialysis and Renal Transplant Division Department of Medical Sciences \u201cCitt\u00e0 della Salute e della Scienza\u201d Hospital University of Turin Turin Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Camussi","sequence":"additional","affiliation":[{"name":"Stem Cell Laboratory Department of Medical Sciences University of Turin Turin Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isabella","family":"Abbasciano","sequence":"additional","affiliation":[{"name":"Renal Transplant Center \u201cA. Vercellone\u201d, Nephrology, Dialysis and Renal Transplant Division Department of Medical Sciences \u201cCitt\u00e0 della Salute e della Scienza\u201d Hospital University of Turin Turin Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonella","family":"Barreca","sequence":"additional","affiliation":[{"name":"Division of Pathology Department of Medical Sciences \u201cCitt\u00e0 della Salute e della Scienza\u201d Hospital University of Turin Turin Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristiana","family":"Caorsi","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences Immunogenetic and Transplant Biology Center \u201cCitt\u00e0 della Salute e della Scienza\u201d Hospital University of Turin Turin Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabrizio","family":"Fop","sequence":"additional","affiliation":[{"name":"Renal Transplant Center \u201cA. 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