TY  - JOUR
AU  - Chen, Alisia
AU  - Park, Jeong M.
PY  - 2026
DA  - 2026/02/24
TI  - Novel Therapies for the Treatment of Antibody Mediated Rejection in Solid Organ Transplantation: A Systematic Review
JO  - OBM Transplantation
SP  - 267
VL  - 10
IS  - 01
AB  - Antibody mediated rejection (AMR) is a considerable cause of late allograft failure in solid organ transplantation. Conventional approaches, using plasmapheresis, intravenous immunoglobulin, rituximab, bortezomib, and eculizumab have been unsuccessful in improving graft survival. This review aims to assess emerging therapies for AMR treatment across all organs. Using a PubMed search, literature published up to July 20, 2025 regarding tocilizumab, clazakizumab, carfilzomib, daratumumab, imlifidase, felzartamab, and obinutuzumab were reviewed. Articles were included if available in English, full-text, and reported clinical efficacy outcomes, and excluded if they discussed non-AMR indications or were review articles, single case reports, opinion pieces, protocols, animal studies, or in vitro studies. A total of 28 studies were included, and grouped by drug, organ, and indication. Quality was rated with the Newcastle-Ottawa Scale. The majority of evidence was with single-center retrospective studies and kidney transplantation. Tocilizumab demonstrated the most promise for stabilizing graft function in kidney chronic active AMR (cAMR). Clazakizumab failed to meet its primary efficacy outcome in its cAMR phase III study despite encouraging findings in earlier trials. Carfilzomib may be considered in acute AMR when toxicities preclude use of bortezomib, but comes with risks of nephrotoxicity. Evidence to support daratumumab’s utility in acute AMR is limited to highly heterogenous case series. Imlifidase, felzartamab, and obinutuzumab are not widely studied but may be potential therapies in the future. Studies comparing these therapies to standard of care are needed to establish the place in therapy of these agents. Additionally, there is a need to identify patient characteristics most predictive of clinical success.
SN  - 2577-5820
UR  - https://doi.org/10.21926/obm.transplant.2601267
DO  - 10.21926/obm.transplant.2601267
ID  - Chen2026
ER  -