Daratumumab in Antibody-Mediated Rejection After Kidney Transplantation: Mechanistic Rationale, Published Clinical Experience, and a Single-Center Case Series.
Srilekha Sridhara, Elizabeth L Cho, Joelle E Nelson et al.
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Case in brief
Two highly sensitized kidney transplant recipients presented with early acute antibody-mediated rejection (AMR) characterized by persistent donor-specific antibodies (DSAs) despite first-line therapies. Biopsies revealed chronic active AMR in one patient and ongoing AMR in the other. Treatment with subcutaneous daratumumab led to a durable reduction in DSAs and stabilization or improvement in renal function.
Diagnostic / clinical pearl
Daratumumab may be an effective adjunctive therapy for refractory AMR in kidney transplant recipients with persistent DSAs.
Why it matters
This case highlights the potential of targeting plasma cell-mediated alloantibody production in managing difficult cases of AMR, warranting further investigation into its use in transplantation.