A Pilot Trial of Clazakizumab in Late ABMR

Inclusion Criteria: * Voluntary written informed consent * Age \>18 years * Functioning living or deceased donor allograft after ≥365 days post-transplantation * eGFR \>30 ml/min/1.73 m2 * Detection of HLA class I and/or II antigen-specific antibodies (preformed and/or de novo DSA). * Acute/active or chronic/active ABMR (±C4d in PTC) according to Banff 2013/2015 * Molecular ABMR score (ABMRpm) ≥0.2 Exclusion Criteria: * Patients actively participating in another clinical trial * Age ≤18 years * Female subject is pregnant or lactating * Index biopsy results: * T-cell-mediated rejection classified Banff grade ≥I * De novo or recurrent severe thrombotic microangiopathy * Polyoma virus nephropathy * De novo or recurrent glomerulonephritis * Acute rejection treatment \<3 month before screening * Acute deterioration of graft function (eGFR decline within 1-3 months \>25%) * Nephrotic range proteinuria \>3500 mg/g protein/creatinine ratio * Active viral, bacterial or fungal infection precluding intensified immunosuppression * Active malignant disease precluding intensified immunosuppressive therapy * Abnormal liver function tests (ALT, AST, bilirubin \> 1.5 x upper limit of normal) * Other significant liver disease * Latent or active tuberculosis (positive QuantiFERON-TB-Gold test, Chest X-ray) * Administration of a live vaccine within 6 weeks of screening * Neutropenia (\<1 G/L) or thrombocytopenia (\<100 G/L) * History of gastrointestinal perforation, diverticulitis, or inflamm…