A multicenter registry study of the CD38 antibody daratumumab for the treatment of microvascular inflammation following kidney transplantation
Year: 2026
Type: article
Study design: Observational Study
Abstract: Introduction Microvascular inflammation (MVI) on kidney biopsy is associated with reduced graft survival following kidney transplantation (KT). CD38- targeting regimens, including the monoclonal antibody daratumumab, have recently emerged as a promising therapeutic strategy to counteract MVI and stabilize graft function. Methods Here, we retrospectively collected data on eGFR, albuminuria, kidney allograft pathology, donor specific antibodies (DSA) and donor-derived cell-free DNA (dd-cfDNA) levels from 70 KT patients both prior to and after initiation of daratumumab treatment. Safety signals were also documented. Results The study cohort consisted of 59 patients diagnosed with antibody mediated rejection (AMR) and 11 patients showing DSA- and C4d-negative MVI. Median time between transplantation and diagnosis of MVI was 36 months. Daratumumab treatment was initiated at a median of 1.6 months following diagnosis of MVI. A mixed linear model showed stabilization of eGFR from -1.6 ml/min/1.73m 2 /month in the year prior to the diagnosis of MVI to +0.3 83 ml/min/1.73m 2 /month after starting daratumumab. Six patients lost their graft during follow-up. Median albuminuria and dd-cfDNA levels decreased early during treatment, whereas the effect on DSA was heterogeneous. Both the number of doses and treatment duration had no measurable impact on outcome. Conclusions Our preliminary data suggests efficacy of daratumumab in stabilizing kidney function in KT recipients with MVI.
Source: Kidney International
Authors: Thomas Drasch, Katharina A. Mayer, Georg A. Böhmig, Aylin Akifova, Fabian Halleck, Klemens Budde, David Rohlfing, Christian Hinze, Malte Kluger, Florian Grahammer, Jan Kowald, Sebastian Baatz, Stefan Reuter, Stephan Kemmner, Tobias Seibt, Mareen Pigorsch, Julia Beck, Kirsten Bornemann-Kolatzki, Ekkehard Schütz, Michael Oellerich, Bernhard Banas, Daniel Zecher
Institutions: University Hospital Regensburg, Medical University of Vienna, Charité – Universitätsmedizin Berlin, Medizinische Hochschule Hannover, University Medical Center Hamburg-Eppendorf, University Hospital Leipzig, Leipzig University, University of Münster, University Hospital Münster, LMU Klinikum, Ludwig-Maximilians-Universität München, Niedersächsische Staats- und Universitätsbibliothek Göttingen, Insight Molecular Diagnostics, Inc (United States), Universitätsmedizin Göttingen
Language: English
Subfield: Transplantation
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,500
OpenAlex ID: W7170192012