Antibody-mediated rejection-treatment standard.

Despite being recognized >25 years ago, AMR treatment remains unstandardized, and no therapy has gained robust regulatory approval. While uncontrolled series have shown promise, few well-designed trials exist, with most yielding negative results.

尽管AMR在25多年前就被认识到了，但其治疗仍然没有标准化，没有任何疗法获得有力的监管批准。虽然未受控的系列研究显示了希望，但设计良好的试验很少，大多数结果都是负面的。

In the absence of strong trial data, a Transplantation Society expert consensus recommended potential treatment options with low levels of evidence, tailored to clinical phenotypes.

在缺乏强有力的试验数据的情况下，移植学会的专家共识推荐了低水平证据的潜在治疗方案，这些方案是根据临床表型量身定制的。

Here, we re-evaluate the current evidence for AMR treatment decisions.

在这里，我们重新评估了当前对AMR（抗体介导的排斥反应）治疗决策的证据。

We conclude that steroids, rituximab, bortezomib, and interleukin-6 (IL-6) antagonists lack sufficiently robust evidence to support their use in AMR.

我们得出结论，类固醇、利妥昔单抗、硼替佐米和白细胞介素-6(IL-6)拮抗剂缺乏足够有力的证据来支持它们在AMR中的使用。

For early AMR, antibody depletion using immunoadsorption could be considered as an alternative to plasmapheresis.

对于早期AMR，可以考虑使用免疫吸附进行抗体耗竭作为血浆置换的替代方案。

High-dose intravenous immunoglobulin (IVIG) may be added, though the supporting evidence remains limited.

尽管支持性证据仍然有限，但可以考虑添加高剂量静脉注射免疫球蛋白（IVIG）。

While previous trials primarily targeted the cause of AMR, recent data on the successful reversal of AMR activity by CD38 antibodies-particularly recent phase 2 trial results-suggest that targeting the cellular inflammation resulting from antibody binding to the endothelium could be a rational approach.

虽然之前的试验主要针对AMR的原因，但最近的数据，特别是关于CD38抗体成功逆转AMR活动的第二阶段试验结果表明，针对抗体与内皮结合引起的细胞炎症可能是一个合理的方法。

Along these lines, in severe early AMR, complement inhibition may also be an option.

在这方面，对于严重的早期抗体介导的移植排斥反应（AMR），补体抑制也可能是另一种选择。

Ongoing phase 2 trials evaluating prolonged courses of high-dose IVIG, the neonatal Fc receptor blocker efgartigimod, the tyrosine kinase inhibitor fostamatinib, and the complement inhibitor BIVV020, along with phase 3 trials of the anti-IL-6 receptor antibody tocilizumab and the CD38 antibody felzartamab, offer hope for effective, approved therapies targeting different aspects of AMR pathobiology.

正在进行的2期试验评估了长期使用高剂量静脉注射免疫球蛋白（IVIG）、新生儿Fc受体阻断剂efgartigimod、酪氨酸激酶抑制剂fostamatinib以及补体抑制剂BIVV020，以及3期试验中的抗IL-6受体抗体tocilizumab和CD38抗体felzartamab，为针对AMR病理生物学不同方面的有效、批准的治疗方法带来了希望。