This multicenter retrospective registry study evaluated daratumumab (anti-CD38 monoclonal antibody) in 70 kidney transplant recipients with microvascular inflammation (MVI) — 59 with antibody-mediated rejection (AMR) and 11 with DSA- and C4d-negative MVI — tracking eGFR, albuminuria, DSA, and donor-derived cell-free DNA (dd-cfDNA) before and after treatment initiation.
Daratumumab stabilized eGFR, shifting the trajectory from -1.6 ml/min/1.73m²/month in the year before MVI diagnosis to +0.3 ml/min/1.73m²/month after starting treatment; 6 of 70 patients lost their graft during follow-up, and median albuminuria and dd-cfDNA levels declined early in treatment, though DSA responses were heterogeneous.
- Retrospective registry design without a control arm limits causal inference. - Number of doses and treatment duration had no measurable impact on outcome, raising questions about optimal dosing strategy. - Small cohort (n=70) with mixed MVI subtypes (AMR vs. DSA/C4d-negative) limits generalizability and subgroup analysis.
Daratumumab appears to stabilize kidney function in transplant recipients with MVI and may reduce albuminuria and dd-cfDNA early in the course of treatment. These preliminary findings support consideration of daratumumab in this setting, but prospective controlled trials are needed before routine use.
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