Daratumumab treatment in six highly sensitised solid organ transplant recipients: A case series and literature review

Abstract

We report data on six kidney or heart recipients who were administered daratumumab to treat or prevent antibody‐mediated rejection (ABMR). To date, data are scarce concerning the use of daratumumab in solid organ transplantation and most reports show a decrease in donor‐specific antigen (DSA) levels and an improvement in ABMR using a multiple myeloma daratumumab administration scheme, that is, with sequential systematic administration. Here, we report on the efficacy of daratumumab 1/ in reducing the histological signs of ABMR, 2/ in reducing the ability of DSA to bind to donor cells in vitro through negativation of flow cytometry crossmatching, 3/ in preferentially being directed towards antibodies sharing epitopes, suggesting that daratumumab may specifically target activated plasma cells, 4/ and when administered as a single dose. This last point suggests, for the first time, that, as for rituximab in auto‐immune diseases, the scheme for daratumumab administration could be different for targeting DSA‐producing plasma cells than for tumour cells.