Review of the Clinical and Economic Burden of Antibody-Mediated Rejection in Renal Transplant Recipients
Abstract
Unlabelled Antibody-mediated rejection (AbMR) is a leading cause of late graft loss in kidney transplant recipients, accounting for up to 60% of late graft failures. AbMR manifests as two distinct phenotypes: the first occurs in the immediate post-transplant period in sensitized patients; the second occurs in the late post-transplant period and has been associated with non-adherence to immunosuppression. The present review summarizes the current treatment options for AbMR, its clinical and economic burden, and approaches for reducing the risk of AbMR. While AbMR is typically refractory to treatment with corticosteroids, there are numerous other approaches focused on removal, inhibition or neutralization of donor-specific antibodies, or inhibition of complement-mediated allograft damage. AbMR treatment is generally expensive with one US study reporting costs of USD 49,000-155,000 per episode. However, leaving AbMR untreated puts patients at high risk of capillaritis, microangiopathy, necrosis and graft failure, which may ultimately result in much greater costs associated with a return to dialysis. Given the barriers to treatment, which include the high cost and the fact that pharmacologic treatments are currently used off-label, prevention of AbMR is important, with improvement in patient adherence to immunosuppression a key strategic approach that may be worthy of further evaluation.Funding Astellas Pharma EMEA Limited.
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Lower adherence levels are associated with an increase in healthcare costs.
“with special emphasis on the association of lower adherence levels with an increase in healthcare costs [10].”
From Effectiveness of Expressive Writing in Kidney Transplanted Patients: A Randomized Controlled Trial Study (2022) · cites this paper as [10]
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An, L., Affdal, A. O., Ballesteros, F., Malo, M.-F. A., Cochran-Mavrikakis, S.-L., Sancho, C., Tousignant, N., Bryan, S., Keown, P., Sapir‐Pichhadze, R., et al. (2026) · Canadian Journal of Kidney Health and Disease · doi:10.1177/20543581251412195
Prédiction du risque et construction de scores pronostiques en transplantation rénale
Raynaud, M. (2021) · theses.fr (ABES) · doi:10.70675/50325f4az3937z4cffz9d46zccde87f71cf2
Cooper, J. T., & Schneider, J. E. (2026) · Journal of health economics and outcomes research · doi:10.36469/001c.146282
Cooper, J. T. (2026) · Journal of health economics and outcomes research · doi:10.36469/jheor.2026.146282
- Authors
- Muduma, G., Odeyemi, I., Smith-Palmer, J., & Pollock, R. F.
- Affiliations
- Astellas Pharma (United Kingdom) (GB)
- Corresponding author
- Muduma, Gorden
- ORCID
- Pollock, Richard F.
- Venue
- Advances in Therapy
- Published
- 2016-02-23
- Volume
- 33
- Issue
- 3
- Pages
- 345-356
- ISSN
- 0741-238X (ISSN-L)
- 1865-8652
- OpenAlex
- W2281327633
- Cited by
- 35
- References
- 53
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 6 · 2023: 1 · 2022: 3 · 2021: 5 · 2020: 5 · 2019: 2 · 2018: 3 · 2017: 1
- FWCI
- 0.47
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Advances in Therapy (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Astellas Pharma Europe
- Topics
- Health Sciences › Medicine › Transplantation › Renal Transplantation Outcomes and Treatments
- Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Organ Donation and Transplantation
- Keywords
- antibody-mediated rejection, kidney transplantation, graft loss, donor-specific antibodies, immunosuppression adherence, treatment costs, off-label drug use, graft failure prevention, capillaritis
- MeSH terms
- Adult, Female, Graft Rejection, Humans, Middle Aged, Retrospective Studies, Kidney Transplantation
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