Abstract: FR-PO1179
Effect of Current Antibody-Mediated Rejection (AMR) Treatments on Microvascular Inflammation (MVI) in Kidney Transplant Recipients: A Rapid Literature Review (RLR) and Meta-Analysis
Session Information
- Transplantation: Clinical - Rejection, Biomarkers, and Pharmacology
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Wiseman, Alexander C., AdventHealth Transplant Institute, Denver, Colorado, United States
- Diebold, Matthias, Medical University of Vienna, Vienna, Austria
- Patel, Samir, Biogen, Cambridge, Massachusetts, United States
- Butcher, Brandon, Biogen, South San Francisco, California, United States
- Stong, Laura, Biogen, Cambridge, Massachusetts, United States
- Ly, Connie, Cytel, Cambridge, Massachusetts, United States
- Jangra, Vikas, Cytel, Cambridge, Massachusetts, United States
- Liu, Mingxin, Cytel, Cambridge, Massachusetts, United States
- Tzonev, Cristiana, Cytel, Cambridge, Massachusetts, United States
- Marcano Belisario, Jose Salvador, Cytel, Cambridge, Massachusetts, United States
- Cravedi, Paolo, Icahn School of Medicine at Mount Sinai, New York, New York, United States
Background
AMR is a major cause of allograft failure in kidney transplant recipients. MVI is the hallmark histologic feature of AMR, defined by the presence of glomerulitis (g) and/or peritubular capillaritis (ptc). MVI is an independent predictor of chronic lesions and graft loss; however, the effect of current AMR treatments on MVI has not been comprehensively evaluated. This RLR and meta-analysis evaluated the impact of AMR therapies on MVI scores.
Methods
A Medline-based RLR (Jan 2000-Mar 2026) identified studies reporting MVI scores in kidney transplant recipients treated for acute/active or chronic active AMR. The RLR was limited to studies evaluating combinations of apheresis (plasmapheresis or immunoadsorption), intravenous immunoglobulin (IVIG), and steroids, with or without rituximab. Study characteristics and outcomes were extracted; in some instances, data conversion (medians to means) or digitization was required for meta-analysis. A random-effects meta-analysis evaluated change in MVI scores pre-treatment to 6 (range, 3-9) months post-treatment; sensitivity analyses were performed to account for differences in follow-up duration and studies that may overinfluence the results.
Results
The RLR identified 17 primary publications reporting g, ptc, or MVI scores from real-world studies (n=15) and randomized controlled trials (n=2). Regimens evaluated included combinations of apheresis/IVIG/steroids with (n=13) and without rituximab (n=6). I2 scores demonstrated moderate to moderately high heterogeneity across studies. Pooled analyses showed a small but statistically significant reduction from baseline in total MVI score at 6 months (−0.57; 95% CI, −0.79, −0.34), with similar changes in g and ptc scores (Figure). Sensitivity analyses involving 3- and 12-month timepoints, and of rituximab-containing regimens only, were similar.
Conclusion
Current treatments for AMR are associated with small, and unlikely clinically meaningful, reductions in MVI scores at 6 months. These data provide a benchmark for MVI response with commonly used treatments, underscoring the need for therapies that more effectively address microvascular injury to the graft.
Funding
- Commercial Support – Biogen