Korean J Transplant.  2023 Nov;37(Suppl 1):S75. 10.4285/ATW2023.F-6532.

Efficacy and safety of eculizumab for treatment of antibody-mediated rejection following renal transplantation

• Kim YN
• Kwon D
• Jung J
• Seo H
• Kim K
• Shin HS
• Park BH
• Shin HS
• Jung Y
• Rim H

• KMID: 2551662
• DOI: http://doi.org/10.4285/ATW2023.F-6532

Abstract

Background
We evaluated the efficacy and safety of eculizumab in comparison with plasmapheresis (PP) and intravenous im-munoglobulin (IVIG) therapy in renal transplant recipients diagnosed with antibody-mediated rejection (AMR).
Methods
This was a multi-center, open-label, prospective, randomized analysis. The patients were randomized by therapy type (eculizumab infusions or standard of care [SOC]: PP/IVIG). The patients (eculizumab arm: seven patients, SOC arm: four patients) were evaluated for the continued presence of donor-specific antibodies (DSAs) and C4d (staining on biopsy), as well as histological evidence, using repeat renal biopsy after treatment.
Results
The allograft biopsies revealed that eculizumab did not prevent the progression to transplant glomerulopathy. Only two patients in the SOC arm experienced rejection reversal, and no graft losses occurred in either group. Following AMR treat-ment, the DSA titers generally decreased compared to titers taken at the time of AMR diagnosis. There were no serious adverse effects in the eculizumab arm.
Conclusions
Eculizumab alone cannot treat AMR effectively and does not prevent acute AMR from progressing to chronic AMR or transplant glomerulopathy. However, it should be considered as a potential alternative therapy because it may be associated with decreased DSA levels.