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Despite standard of care treatment, including intravenous immunoglobulin, therapeutic plasma exchange, and steroids, the patient exhibited persistent donor-specific antibodies and renal allograft injury. Given elevated interleukin-6 levels, tocilizumab, an IL-6 receptor monoclonal antibody, was started with marked improvement in serum creatinine, and stabilization of the allograft injury. This case highlights the potential of interleukin-6 blockade as a treatment for refractory chronic active antibody-mediated rejection, particularly in the context of interleukin-6-mediated injury.<\/jats:p>","DOI":"10.1177\/08850666251414372","type":"journal-article","created":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T19:37:14Z","timestamp":1769024234000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Thinking Outside the Box: Managing Refractory Antibody-Mediated Rejection Based on Injury-Related Phenotype to Preserve Renal Function in Patients Where Multiple Rounds of Standard Care Treatment Have Failed"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8149-5118","authenticated-orcid":false,"given":"Rajeev","family":"Sharma","sequence":"first","affiliation":[{"name":"West Virginia 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