Kidney Week

Abstract: TH-PO1222

Daratumumab for Antibody-Mediated Rejection in Pediatric Kidney Transplant Recipients: A Single-Center Case Series

Session Information

• Pediatric Nephrology: CV Health, CKD, AKI, Dialysis, Transplantation, and Health Services Research
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

• 1800 Pediatric Nephrology

Authors

• Balani, Shanthi Sree, University of Minnesota Medical School, Minneapolis, Minnesota, United States

Shanthi Sree Balani, MD

• Mostafa, Omar, University of Minnesota Medical School, Minneapolis, Minnesota, United States

Omar Mostafa, MD

• Jensen, Chelsey Joy, M Health Fairview, Minneapolis, Minnesota, United States

Chelsey Joy Jensen, PharmD

• Kizilbash, Sarah J., University of Minnesota Medical School, Minneapolis, Minnesota, United States

Sarah J. Kizilbash, MD, MS

Background

Antibody-mediated rejection(AMR) is a major cause of pediatric kidney allograft failure with limited treatment options. Daratumumab, an anti-CD38 monoclonal antibody that depletes plasma cells, has shown efficacy in adult transplant recipients, but pediatric data are scarce.

Methods

Retrospective single-center case series of 4 pediatric kidney transplant recipients receiving daratumumab for biopsy-proven AMR. Demographics, serial Banff scores, donor-specific antibody (DSA) MFI pre/post, creatinine, and outcomes were abstracted.

Results

Clinical characteristics and biopsy findings are presented in Table 1. All recipients received pulse steroids and plasmapheresis; 3 received thymoglobulin, and 1 received rituximab for AMR treatment prior to daratumumab. Three of the four repeat biopsies showed resolving AMR with near complete resolution of microvascular inflammation. All 4 recipients had Class II DSA pre-daratumumab (immunodominant MFI 10,618–20,756), and all showed post-treatment reductions of 36–91% (median 60%). Functioning grafts had ≥80% reduction; failed grafts had ≤40%. At median follow-up of 5.7 months (3.2–8.2 months), 2 had functioning grafts with improved creatinine and 2 progressed to hemodialysis (HD). Adverse events included 1 delayed infusion reaction and 2 infections (CMV viremia, norovirus).

Conclusion

Daratumumab was well-tolerated and with significant improvement in DSA and almost complete resolution of inflammation, however clinical outcomes remained variable. Further investigation is warranted.

Acknowledgment

AI tools were used to improve readability and image generation.