OBJECTIVES: Antibody-mediated rejection (AMR) is a significant complication after kidney transplantation and is recognized as a major cause of acute and chronic kidney allograft dysfunction with an eventual progression to allograft failure. This review aims to highlight the disease burden of chronic and chronic active AMR, including epidemiology, clinical, humanistic, and economic outcomes, and identify unmet needs and gaps in current knowledge.

METHODS: A targeted literature search was conducted to identify relevant papers published between January 2013 and August 2023 in the following scope markets: US, UK, Germany, France, China, and Japan.

RESULTS: The incidence of AMR ranges from 1% to 15% and chronic AMR from 8% to 20% in kidney transplant patients. The presence of donor-specific antibodies (DSAs) ranges from 23% to 78%. Graft failure in patients with AMR ranges from 25% in 6 months post-transplant to 50% in late post-transplant patients with chronic AMR, while graft loss ranges from 15% in patients who are DSA+ at 2-year follow-up post-transplant to 24% in patients with AMR who did not receive antibody-targeting-based therapy at 1-year post-transplant. The humanistic burden of AMR is largely uncharacterized. A lack of health-related quality of life (HRQL) data is likely to be a limitation for payers. Patients with AMR incur higher healthcare resource utilization costs vs matched patients without AMR, with a higher magnitude of nephrology visits both pre- and post-AMR event. Inpatient costs constitute the highest costs for patients with AMR, while pharmacy claims and outpatient costs are the lowest.

CONCLUSIONS: The increased graft failure rates experienced by patients with AMR are associated with increased healthcare costs. Future research should prioritize the collection of HRQL and economic data, linking clinical and economic outcomes to better inform payer decisions.