Blood group-specific apheresis in combination with daratumumab as a rescue therapy of acute antibody-mediated rejection in a case of ABO- and human leukocyte antigen-incompatible kidney transplantation.

在 ABO 和人类白细胞抗原不相容的肾移植病例中 ， 血型特异性单采术与达雷妥单抗联合作为急性抗体介导的排斥反应的抢救疗法。

• 发表时间: 2023
• 来源期刊: SAGE Open Med Case Rep
• DOI: 10.1177/2050313X231211050
• PMID: 38022864
• 文章类型: Case Reports
• 作者列表: Süsal CC,Kraft L,Ender A,Süsal C,Schwenger A,Amann K,Böhmig GA,Schwenger V

关键词: Case report; HLA incompatibility; antibody-mediated rejection; blood-group incompatibility; daratumumab; kidney transplantation; living-donor transplantation; rejection therapy

Abstract

We report a case of antibody-mediated rejection treated with the human CD38 monoclonal antibody daratumumab in a 58-year-old female patient with end-stage kidney disease due to autosomal dominant polycystic kidney disease who received an ABO- and human leukocyte antigen antibody-incompatible living donor kidney transplant. The patient experienced an episode of severe antibody-mediated rejection within the first week of transplantation. Blood-group-antibody selective immunoadsorption in combination with administration of four doses of daratumumab (each 1800 mg s.c.) led to a persistent decrease of ABO- and more interestingly donor-specific human leukocyte antigen antibody reactivity and resulted in clinical and histopathological remission with full recovery of graft function, which has remained stable until post-transplant day 212. This case illustrates the potential of targeting CD38 in antibody-mediated rejection.

摘要

我们报道了一例人CD38单克隆抗体达雷木单抗治疗的抗体介导的排斥反应病例，该病例是一名58岁的女性患者，该患者因常染色体显性遗传多囊肾疾病而患有终末期肾病，接受了ABO和人类白细胞抗原抗体不相容的活体供者肾移植。患者在移植的第一周内经历了严重的抗体介导的排斥反应。血型抗体选择性免疫吸附与四剂达雷妥单抗（每剂1800mg皮下注射）联合使用导致ABO-更有趣的是供体特异性人类白细胞抗原抗体反应性持续降低，并导致临床和组织病理学缓解，移植物功能完全恢复，一直保持稳定，直到移植后第212天。这种情况说明了在抗体介导的排斥中靶向CD38的潜力。