Advances in Therapy

, Volume 33, Issue 3, pp 345–356 | Cite as

Review of the Clinical and Economic Burden of Antibody-Mediated Rejection in Renal Transplant Recipients

  • Gorden Muduma
  • Isaac Odeyemi
  • Jayne Smith-Palmer
  • Richard F. Pollock


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.


Burden Cost Graft rejection Nephrology Renal transplant 



This study was initiated and funded by Astellas Pharma EMEA Limited, Chertsey, UK. The article processing charges for this publication were funded by Astellas Pharma EMEA Limited. All authors were involved in the development and writing of this review. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published. There were no other contributors to the manuscript aside from the listed authors.


Gorden Muduma and Isaac Odeyemi are full-time employees of Astellas Pharma EMEA Limited, the manufacturer of tacrolimus (Prograf®) and extended-release tacrolimus (Advagraf®). Jayne Smith-Palmer and Richard F. Pollock are full-time employees of Ossian Health Economics and Communications GmbH, which received consultancy fees from Astellas Pharma EMEA Limited.

 Compliance with Ethics Guidelines

This article is based on previously conducted studies and does not involve any new studies of human or animal subjects performed by any of the authors.

Supplementary material

12325_2016_292_MOESM1_ESM.pdf (270 kb)
Supplementary material 1 (PDF 269 kb)


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Copyright information

© Springer Healthcare 2016

Authors and Affiliations

  • Gorden Muduma
    • 1
  • Isaac Odeyemi
    • 1
  • Jayne Smith-Palmer
    • 2
  • Richard F. Pollock
    • 2
  1. 1.Astellas Pharma EMEA LimitedChertseyUK
  2. 2.Ossian Health Economics and CommunicationsBaselSwitzerland

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