Abstract: FR-PO1178
Nephrologist Perceptions of Unmet Needs in the Treatment of Antibody-Mediated Rejection: Results from a Real-World Survey in Germany and the United States
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
- Gupta, Aditi, Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, United States
- Hinze, Christian, Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
- Patel, Samir, Biogen, Cambridge, Massachusetts, United States
- Clayton, Sarah, Adelphi Real World, Bollington, England, United Kingdom
- Lowe, Mollie, Adelphi Real World, Bollington, England, United Kingdom
- Le Brocq, Laura, Adelphi Real World, Bollington, England, United Kingdom
- Stenson, Katie, Biogen, Cambridge, Massachusetts, United States
Background
Antibody-mediated rejection (AMR) is a leading cause of kidney allograft failure. AMR is treated with a wide range of therapies guided primarily by consensus-based recommendations; however, evidence supporting their efficacy is limited, and no treatments approved for AMR exist. We aimed to understand and describe how nephrologists perceive the efficacy, tolerability, and burden of current AMR treatments, as well as unmet needs in AMR.
Methods
Data are from the Adelphi Real World AMR Disease Specific Programme™, a cross-sectional survey of nephrologists in Germany and the USA collected between Feb–Mar 2026. Descriptive analyses were conducted.
Results
Interim results from 23 nephrologists (Germany, n=14; US, n=9) are presented. Most nephrologists (17/23, 74%) indicated that AMR could occur despite adequate or optimal maintenance immunosuppression. When asked about commonly considered first-line therapy for AMR, nephrologists identified a broad range of treatments, including anti-CD20 agents (n=20, 87%), plasmapheresis (n=19, 83%), intravenous immunoglobulin (n=19, 83%), pulse corticosteroids (n=19, 83%) and optimization of maintenance immunosuppression (n=15, 65%). In addition, 21/23 (91%) reported a preference for combination therapy with different mechanisms of action.
Reported unmet needs in the management of AMR were centered on the efficacy of current treatments (n=7, 30%) and the need for more effective treatment options (n=7, 30%). A majority (n=19, 82%) agreed the lack of approved treatments is a challenge in managing AMR. Only 1/23 (4%) reported complete satisfaction with current treatments. Among those reporting incomplete satisfaction, the most frequent reasons were lack of efficacy (91%), side effects/toxicity (50%), poor tolerability (45%), and administrative burden (36%).
Treatment goals ranked highest included promoting long-term graft survival (n=17, 74%), maintaining patients' quality of life (QoL) (n=15, 65%), and maximizing allograft function (n=15, 65%).
Conclusion
The lack of approved treatments, limited efficacy, and poor tolerability of available treatment options are challenges in managing patients with AMR post kidney transplant and contribute to variability in clinical practice. These findings underscore the need for efficacious treatments that address the underlying disease mechanisms and improve outcomes and patient QoL.