Preliminary clinical exploration of anti-CD38 monoclonal antibody in the treatment of late antibody-mediated rejection after kidney transplantation
10.3760/cma.j.cn421203-20231007-00118
- VernacularTitle:抗CD38单抗治疗肾移植晚期抗体介导排斥反应的临床初步探索
- Author:
Zhiliang GUO
1
;
Rula SA
;
Daqiang ZHAO
;
Hui GUO
;
Guangyuan ZHAO
;
Yuhao TU
;
Songxia LI
;
Lan ZHU
;
Gang CHEN
Author Information
1. 华中科技大学同济医学院附属同济医院器官移植研究所，器官移植教育部重点实验室，国家卫生健康委员会器官移植重点实验室，中国医学科学院器官移植重点实验室，武汉 430030
- Keywords:
Kidney transplantation;
Rejection;
Donor-specific antibody;
Daratumumab
- From:
Chinese Journal of Organ Transplantation
2024;45(9):622-627
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the efficacy and safety of daratumumab in late antibody-mediated rejection (late AMR) after kidney transplantation (KT).Methods:From December 2020 to December 2021, the relevant clinical data were reviewed for 8 patients with late AMR after receiving daratumumab at Affiliated Tongji Hospital. In intensive phase, the combination of plasma exchange (PP)/intravenous immunoglobulin (IVIG) and daratumumab were dosed once a week; in maintenance phase, once every 2 to 4 weeks. The levels of donor-specific antibody (DSA) and renal function were compared pre-treatment and Month 3/12 post-treatment. The treatment-related toxicities were observed. Independent sample T test was utilized for inter-group comparison.Results:The median treatment course during intensive period was 9(4-17) sessions. Maintenance treatment lasted for 5 to 19 months and 2 cases withdrew after 5 to 6 treatments for achieving antibody clearance. A total of 11 DSAs were detected in 8 recipients. At Month 3/12, mean fluorescent intensity (MFI) of DSA was 6 016±4 775 and 6 438±3 668. Both were significantly lower than 11 944±5 237 pre-treatment and the difference was statistically significant ( P=0.012, 0.004). Seven recipients achieved stable renal function during treatment and one recipient resumed hemodialysis at Month 18 due to acute rejection. Glomerular filtration rate of 7 recipients was (40.6±20.1), (53.6±20.9) and (49.0±17.2) ml·min -1· (1.73 m 2) -1 pre-treatment and Month 3/12 and no significant differences existed among different timepoints. During follow-ups, 2 cases developed mild nasal congestion during an early stage of daratumumab infusion while the remainders had no obvious discomfort during infusion and tolerance was decent. Conclusion:Early combination of daratumumab with PP/IVIG, followed by a course of daratumumab has demonstrated an excellent antibody reduction effect on late AMR. During treatment, renal function remains generally stable.
