Abstract: TH-PO821
Pre-Transplant Daratumumab (Dara) and Kidney Transplant Rejection
Session Information
- Transplantation: Clinical - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Amer, Hatem, Mayo Clinic Department of Internal Medicine, Rochester, Minnesota, United States
- Barbir, Elena-Bianca, Mayo Clinic Department of Internal Medicine, Rochester, Minnesota, United States
- El Ters, Mireille, Mayo Clinic Department of Internal Medicine, Rochester, Minnesota, United States
- Leung, Nelson, Mayo Clinic Department of Internal Medicine, Rochester, Minnesota, United States
Background
This study examined the post-kidney transplant outcomes of patients who received Dara, a monoclonal antibody against CD38 positive cells, pre-transplant. Concerns exist that Dara may increase the risk of rejection.
Methods
We identified solitary kidney allograft recipients who received Dara within 180 days pre-transplant in our center. Clinical and laboratory data were abstracted from the chart. Protocol biopsies are routine in our practice.
Results
Ten patients met inclusion criteria. Mean age was 60 (±10) range 36-73 years, there were 7 males, and 7 received a living donor transplant. Induction was with Basiliximab in 7, Alemtuzumab in 2 & Anti-thymocyte globulin in 1. Maintenance immunosuppression consisted of ± corticosteroids, tacrolimus, mycophenolate mofetil in 9 patients, Belatacept replaced tacrolimus in one patient and in one patient sirolimus was substituted for tacrolimus 26 months post-transplant due to microangiopathy. Last dose of dara was 22 (16,30) days prior to transplant. Three patients resumed dara: 11, 24, and 244 days post-transplant. Follow-up was 32 (± 16) months. One patient did not undergo protocol biopsies due to systemic anticoagulation. The remainder had protocol biopsies at the predetermined time points. No graft losses occurred during follow-up. Two patients had subclinical borderline changes (i0, t1) at one year, and (i1, t3) on the two-year protocol biopsy. The latter, after reduction in immunosuppression due to CMV infection (Fig1). Another patient developed severe BK nephropathy that required significant immunosuppression reduction.
Conclusion
In our series of 10 patients, we did not observe any clinical acute cellular rejections. Two patient had subclinical borderline changes, one- and two-years post-transplant. Daratumumab did not appear to increase the risk of rejection.
Rejection free (including borderline changes) kidney graft survival.