Abstract: FR-PO1210
New Desensitisation Strategy: A Case Series of Daratumumab in Highly Sensitised Kidney Transplant Candidates
Session Information
- Transplantation: Clinical - Rejection, Biomarkers, and Pharmacology
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Sinha, Vijay Kumar, Max Super Speciality Hospital Noida, Noida, UP, India
- Khan, Urvashi, Max Super Speciality Hospital Noida, Noida, UP, India
Introduction
Highly sensitized kidney transplant candidates is a therapeutic challenge because of donor-specific antibodies (DSA), positive cross match & limited compatible donor availability. Conventional desensitization using plasmapheresis, IVIG & Rituximab may fail to achieve adequate reduction in alloantibodies, Daratumumab, a human anti-CD38 monoclonal antibody targeting plasma cells, is a promising strategy for antibody depletion by suppressing alloantibody production.
Case Description
Case 1: A 43-year, male with Positive CDC and flow cross match, Luminex SAB- multiple class I and class II DSAs with max MFI 1494 & 16,315 respectively. with Rituximab and Daratumumab (800 mg/ week- 4 dose), DSA levels decreased significantly & CDC became negative,enabling successful transplantation. Post-transplant SAB at 1 & 6 months showed no antibodies with stable graft function (SCr 0.9 mg/dL) at 6 months without rejection or infection.
Case 2: A 46-yr,Female with CDC negative & flow cross match postive, with multiple class I & class II HLA DSAs. Class I DSA (MAX-MFI 2349) & class II DSA (max MFI of 11,438). Post Rituximab & Daratumumab, DSAs reduced substantially, permitting successful transplantation. At 3 month, graft function remained stable (Scr.0.85 mg/dL). Luminex SAB at 3 months shows no antibodies.
Case 3: 43/F, Baseline B-cell CDC & flow cross match positive with Multiple Class I DSA & class 2 DSAs. Following Rituximab Daratumumab,DSA levels declined significantly, enabling successful kidney transplantation. At 1 month graft function remains stable with no DSAs.
Discussion
1. Novel plasma cell targeting approach: Daratumumab depletes CD38-positive plasma cells, leading to effective reduction in DSAs.
2. Synergistic immunomodulation: Combination therapy (Rituximab & Daratumumab) targets both B cells & plasma cells,enhancing desensitization efficacy in highly sensitized recipients.