{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T15:27:16Z","timestamp":1788794836371,"version":"build-2803163510"},"reference-count":22,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,2,24]],"date-time":"2023-02-24T00:00:00Z","timestamp":1677196800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The optimal treatment for chronic active antibody\u2010mediated rejection (ca\u2010AMR) remains unclear. Tocilizumab (TCZ), a monoclonal antibody against IL\u20106, has been proposed as a therapeutic option. We reported our experience treating ca\u2010AMR with TCZ either as the first line option or as a rescue therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We studied 11 adult kidney transplant recipients with biopsy\u2010proven ca\u2010AMR and preserved kidney function (eGFR 57 \u00b1 18) who were treated with TCZ (8 mg\/kg IV monthly). All biopsies were prompted by abnormal surveillance biomarker testing with DSA and\/or dd\u2010cfDNA. Clinical monitoring included dd\u2010cfDNA and DSA testing every 3 months during the treatment with TCZ.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In this cohort, ca\u2010AMR was diagnosed at a median of 90 months (range 14\u2013224) post\u2010transplant, and 4 of 11 patients had DSA negative ca\u2010AMR. Patients received a minimum of 3 months of TCZ, with 6 patients receiving at least 12 months of TCZ. Dd\u2010cfDNA was elevated in all patients, with a median 2.24% at the start of TCZ treatment. After 6 months of TCZ treatment, 8\/11 patients had dd\u2010 cfDNA &lt;1%, and 3\/11 had values &lt;0.5%. Among those who completed at least 12 months of TCZ, dd\u2010cfDNA decreased by 29% at 6 months (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.05) and 47% by 12 months (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.04). DSA also stabilized and, by 12 months, was reduced by 29% (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.047). Graft function remained stable with no graft loss during treatment. There was a nonsignificant trend towards proteinuria reduction. During the course of treatment with tocilizumab, two patients experienced moderate to severe infections.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In our early short\u2010term experience, TCZ appears to reduce graft injury as measured by dd\u2010cfDNA and modulate the immune response as evident by a modest reduction in immunodominant DSA MFI. Allograft function and proteinuria also\u00a0stabilized.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.14936","type":"journal-article","created":{"date-parts":[[2023,2,14]],"date-time":"2023-02-14T18:54:53Z","timestamp":1676400893000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Tocilizumab for treatment of chronic active antibody\u2010mediated rejection in kidney transplant recipients"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3022-8861","authenticated-orcid":false,"given":"Boonphiphop","family":"Boonpheng","sequence":"first","affiliation":[{"name":"Department of Medicine University of Washington Medical Center  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0474-7876","authenticated-orcid":false,"given":"Iris Camille C.","family":"De Castro","sequence":"additional","affiliation":[{"name":"Department 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 Seattle Washington USA"},{"name":"Department of Urology University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5535-352X","authenticated-orcid":false,"given":"Idoia","family":"Gimferrer","sequence":"additional","affiliation":[{"name":"Bloodworks Northwest  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2368-4957","authenticated-orcid":false,"given":"Kelly","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Pathology University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3279-2930","authenticated-orcid":false,"given":"Nicolae","family":"Leca","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Washington Medical Center  Seattle Washington 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