Successful Desensitization with Imlifidase and Daratumumab in a Highly Immunized, Crossmatch Positive, Blood Group-Incompatible Living-Donor Re-Transplant Recipient with Systemic Lupus Erythematosus and Antiphospholipid Syndrome

Schrezenmeier E, Choi M, Globke B, Dörner T, Leimbach A, Osmanodja B, Schramm A, Amann KU, Eckardt KU, Budde K, Öllinger R, Lachmann N, Halleck F (2024)

Publication Type: Journal article

Publication year: 2024

Journal

Transfusion Medicine and Hemotherapy Karger

DOI: 10.1159/000538513

Abstract

Introduction: The transplantation of highly sensitized patients remains a major obstacle. Immunized patients wait longer for a transplant if not prioritized, and if transplanted, their transplant outcome is worse. Case Presentation: We report a successful AB0- and HLA-incompatible living donor kidney transplantation in a 35-year-old female patient with systemic lupus erythematosus (SLE) and antiphospholipid syndrome. The patient had a positive T- and B-cell complement-dependent cytotoxicity (CDC) crossmatch and previous graft loss due to renal vein thrombosis. We treated the patient with intravenous immunoglobulins, rituximab, horse anti-thymocyte globulin, daratumumab, and imlifidase, besides standard immunosuppression. All IgG antibodies were sensitive to imlifidase treatment. Besides donor-specific HLA antibodies, anti-dsDNA antibodies and antiphospholipid antibodies were cleaved. The patient initially had delayed graft function. Two kidney biopsies (day 7 and day 14) revealed acute tubular necrosis without signs of HLA antibody-mediated rejection. On posttransplant day 30, hemodialysis was stopped, and creatinine levels declined over the next weeks to a baseline creatinine of about 1.7 mg/ dL after 12 months. Conclusion: In this case, a novel multimodal treatment strategy including daratumumab and imlifidase enabled successful kidney transplantation for a highly immunized patient with antiphospholipid antibodies.

Authors with CRIS profile

Kerstin Ute Amann Department of Nephropathology

Involved external institutions

Charité - Universitätsmedizin Berlin DE Germany (DE) Berliner Institut für Gesundheitsforschung (BIH) DE Germany (DE)

How to cite

APA:

Schrezenmeier, E., Choi, M., Globke, B., Dörner, T., Leimbach, A., Osmanodja, B.,... Halleck, F. (2024). Successful Desensitization with Imlifidase and Daratumumab in a Highly Immunized, Crossmatch Positive, Blood Group-Incompatible Living-Donor Re-Transplant Recipient with Systemic Lupus Erythematosus and Antiphospholipid Syndrome. Transfusion Medicine and Hemotherapy. https://doi.org/10.1159/000538513

MLA:

Schrezenmeier, Eva, et al. "Successful Desensitization with Imlifidase and Daratumumab in a Highly Immunized, Crossmatch Positive, Blood Group-Incompatible Living-Donor Re-Transplant Recipient with Systemic Lupus Erythematosus and Antiphospholipid Syndrome." Transfusion Medicine and Hemotherapy (2024).

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