Kidney transplantation is generally considered as the best therapeutic approach for patients with end-stage kidney disease. A considerable proportion of patients on the transplant waiting list, nearly one-third, present anti-Human Leukocyte Antigen donor-specific antibodies, a condition that tends to reduce the chances of receiving a transplant and increases the risk of immunological complications after transplantation. Among the different factors influencing graft survival, the immune response remains central in determining long-term outcomes. Antibody-mediated rejection remains a significant clinical challenge, as it contributes to both acute damage and progressive graft deterioration, ultimately affecting its survival. Interleukin-6 has been implicated in several inflammatory and immune regulatory pathways. In kidney transplantation, it is thought to participate in the mechanisms that favor the persistence of plasma cells and the interaction between T and B lymphocytes, thereby sustaining antibody production. By modulating Interleukin-6 signaling, it may be possible to interfere with these processes and limit the extent of alloimmune injury. Tocilizumab, an Interleukin-6 receptor antagonist originally developed for autoimmune conditions, has recently been investigated in the kidney transplant field. Preliminary reports suggest that it could play a role both in desensitization strategies for highly sensitized patients and in the management of antibody-mediated rejection, supporting its potential as an additional option in kidney transplantation.
Mocka et al. (Sat,) studied this question.