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The following is a summary of “Daratumumab followed by tocilizumab for treatment of late antibody-mediated rejection in renal transplant recipients with high or moderate levels of de novo donor-specific antibodies: a pilot study,” published in the January 2025 issue of Nephrology by Guo et al.
Researchers conducted a retrospective study on daratumumab (Dara) and tocilizumab (TCZ) for treating late antibody-mediated rejection in renal transplant recipients. The therapy cleared donor-specific antibody (DSA) and prevented rebound, offering a promising treatment option.
They summarized clinical data from 7 patients with late or chronic active AMR after renal transplantation. Phase 1 involved intensive treatment with DARA plus plasmapheresis (PP)/intravenous immunoglobulins (IVIG), followed by maintenance with Dara alone. In phase 2, patients received TCZ therapy. Clinical indicators included DSA, Banff scores, and renal function.
The results showed that after 4 to 17 weeks of intensive treatment, DSA mean fluorescence intensity (MFI) values fell below 5,000 in 5 of 7 patients. During Dara maintenance, only 1 patient’s DSA became negative, while 6 remained stable or showed rebound. After TCZ treatment, DSA became negative in 3 patients and decreased to < 3,500 in 3 others. Renal function stabilized in all patients. At 24–28 months post-treatment, renal biopsy showed partial remission of microvascular inflammation in 4 of 6 patients. Capillary C4d deposition became negative in all patients (P = 0.001), and interstitial fibrosis and tubular atrophy (i-IFTA) scores significantly decreased (P = 0.012). Other chronic injury scores showed no significant change.
Investigators found that the Dara and TCZ combination effectively desensitized patients, offering a promising approach for optimizing late or chronic active AMR treatment.
Source: bmcnephrol.biomedcentral.com/articles/10.1186/s12882-025-03951-5