ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on X

Kidney Week

Abstract: TH-PO821

Pre-Transplant Daratumumab (Dara) and Kidney Transplant Rejection

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical

Authors

  • Amer, Hatem, Mayo Clinic Department of Internal Medicine, Rochester, Minnesota, United States
  • Barbir, Elena-Bianca, Mayo Clinic Department of Internal Medicine, Rochester, Minnesota, United States
  • El Ters, Mireille, Mayo Clinic Department of Internal Medicine, Rochester, Minnesota, United States
  • Leung, Nelson, Mayo Clinic Department of Internal Medicine, Rochester, Minnesota, United States
Background


This study examined the post-kidney transplant outcomes of patients who received Dara, a monoclonal antibody against CD38 positive cells, pre-transplant. Concerns exist that Dara may increase the risk of rejection.

Methods

We identified solitary kidney allograft recipients who received Dara within 180 days pre-transplant in our center. Clinical and laboratory data were abstracted from the chart. Protocol biopsies are routine in our practice.

Results

Ten patients met inclusion criteria. Mean age was 60 (±10) range 36-73 years, there were 7 males, and 7 received a living donor transplant. Induction was with Basiliximab in 7, Alemtuzumab in 2 & Anti-thymocyte globulin in 1. Maintenance immunosuppression consisted of ± corticosteroids, tacrolimus, mycophenolate mofetil in 9 patients, Belatacept replaced tacrolimus in one patient and in one patient sirolimus was substituted for tacrolimus 26 months post-transplant due to microangiopathy. Last dose of dara was 22 (16,30) days prior to transplant. Three patients resumed dara: 11, 24, and 244 days post-transplant. Follow-up was 32 (± 16) months. One patient did not undergo protocol biopsies due to systemic anticoagulation. The remainder had protocol biopsies at the predetermined time points. No graft losses occurred during follow-up. Two patients had subclinical borderline changes (i0, t1) at one year, and (i1, t3) on the two-year protocol biopsy. The latter, after reduction in immunosuppression due to CMV infection (Fig1). Another patient developed severe BK nephropathy that required significant immunosuppression reduction.

Conclusion

In our series of 10 patients, we did not observe any clinical acute cellular rejections. Two patient had subclinical borderline changes, one- and two-years post-transplant. Daratumumab did not appear to increase the risk of rejection.

Rejection free (including borderline changes) kidney graft survival.