Abstract: SA-PO0991
Successful CD19 Chimeric Antigen Receptor T Cell (CAR-T) Therapy in a Kidney Transplant Recipient with Refractory Post-Transplant Lymphoproliferative Disorder Without Allograft Compromise
Session Information
- Transplantation: Clinical - Case Reports
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Al Haddad, Nadia, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Carter, Jordan, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Seif, Nay, University of Pennsylvania, Philadelphia, Pennsylvania, United States
Introduction
Post-transplant lymphoproliferative disorder (PTLD) is a rare complication in solid organ transplant recipients (SOTR). We present a case of successful CD19 CAR T-cell therapy in a kidney transplant recipient with refractory Epstein Barr Virus (EBV)-negative monomorphic PTLD without kidney allograft rejection.
Case Description
A 50-year-old patient with end-stage kidney disease due to Alport's syndrome underwent deceased donor kidney transplant in 2019. Immunosuppression included tacrolimus, mycophenolate (MMF) and prednisone. In 2024, he was diagnosed with stage I EBV-negative monomorphic PTLD, germinal center B-cell Diffuse Large B-cell Lymphoma involving the small bowel near the donor kidney. MMF was discontinued, tacrolimus was reduced (target trough 3-5 ng/mL) and prednisone 5 mg daily was continued. Despite reduced immunosuppression and multiple chemoimmunotherapy regimens, disease progressed. He was considered for CD19 CAR T-cell therapy with Liscocabtagene Maraleucel. He underwent leukapheresis while on tacrolimus and prednisone. Tacrolimus was held starting 4 weeks prior to CAR T-cell infusion. He received bridging proton therapy and Bendamustine lymphodepletion. He tolerated therapy without evidence of cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome. Kidney function remained stable without clinical or biochemical rejection (Figure 1). 3 months later, a PET-CT showed complete metabolic response. Tacrolimus was resumed at the prior target trough level.
Discussion
CAR T-cell therapy has advanced the management of refractory hematologic malignancies, but its use in SOTR remains limited, partly due to graft rejection concerns. This case shows its potential feasibility without graft compromise using a multidisciplinary approach. As in other cases, calcineurin inhibitors were held pre-infusion and resumed three months post-therapy. Emerging biomarkers such as dd-cfDNA may offer non-invasive monitoring for rejection. Prospective studies are needed to guide immunosuppression in this high-risk group.
Timeline of clinical course