{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T12:24:09Z","timestamp":1793363049065,"version":"4.5.0"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2024,1,14]],"date-time":"2024-01-14T00:00:00Z","timestamp":1705190400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2024,1,14]],"date-time":"2024-01-14T00:00:00Z","timestamp":1705190400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>There is no established treatment for late or chronic antibody-mediated rejection of a kidney graft. Rituximab-based treatment is not effective, since long-lived high-affinity plasma cells do not express CD20 and do not depend on previous maturation steps to generate donor-specific antibodies. Conversely, daratumumab, an anti-CD38 monoclonal antibody, directly targets plasma cells, with proven efficacy in multiple myeloma. Early reports in heart and kidney transplantation showed its efficacy in the setting of antibody-mediated rejection or desensitization. However, the dosage to be\u00a0used was assumed to be the same as in\u00a0multiple myeloma treatment. We present the case of a patient with late antibody-mediated rejection, resistant to two cycles of rituximab-based therapy, who underwent a cycle of plasma exchange and intravenous gammaglobulins preceded and followed by only 2 doses of daratumumab. Bone marrow aspirate after the cycle demonstrated negativization of CD38\u2009+\u2009cells, which was followed by negativization of the donor-specific antibodies and improvement of microinflammation at kidney biopsy. This suggests that the myeloma-like dosage used in previous reports may not be necessary for non-neoplastic diseases like antibody-mediated rejection. We propose a pragmatic approach, based on the assessment of bone marrow plasma cells after treatment, to avoid unnecessary side effects and optimize resources.<\/jats:p>\n                  <jats:sec>\n                    <jats:title>Graphical abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s40620-024-02182-5","type":"journal-article","created":{"date-parts":[[2025,1,13]],"date-time":"2025-01-13T22:46:54Z","timestamp":1736808414000},"page":"739-744","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Searching for the minimum required dose of daratumumab to induce effective plasma cell depletion in antibody-mediated rejection of the kidney graft: a case report"],"prefix":"10.1093","volume":"38","author":[{"given":"Julia","family":"Oll\u00e9","sequence":"first","affiliation":[{"name":"Renal Transplant Unit, Department of Nephrology and Kidney Transplantation Hospital Cl\u00ednic of Barcelona, Carrer Villaroel 170, 08036, Barcelona, Spain 1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Belen","family":"Larque","sequence":"additional","affiliation":[{"name":"Department of Pathology Hospital Cl\u00ednic of Barcelona, Barcelona, Spain 2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos Fernandez","family":"de Larrea","sequence":"additional","affiliation":[{"name":"Department of Hematology, Amyloidosis and Myeloma Unit Hospital Cl\u00ednic de Barcelona, Barcelona, Spain 3"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fritz","family":"Diekmann","sequence":"additional","affiliation":[{"name":"Renal Transplant Unit, Department of Nephrology and Kidney Transplantation Hospital Cl\u00ednic of Barcelona, Carrer Villaroel 170, 08036, Barcelona, Spain 1"},{"name":"Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d\u2019Investigaci\u00f3 Biom\u00e8diques August Pi i Sunyer (IDIBAPS), Barcelona, Spain 4"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Cucchiari","sequence":"additional","affiliation":[{"name":"Renal Transplant Unit, Department of Nephrology and Kidney Transplantation Hospital Cl\u00ednic of Barcelona, Carrer Villaroel 170, 08036, Barcelona, Spain 1"},{"name":"Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d\u2019Investigaci\u00f3 Biom\u00e8diques August Pi i Sunyer (IDIBAPS), Barcelona, Spain 4"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,1,14]]},"reference":[{"issue":"1","key":"2026012110532022400_CR1","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1097\/TP.0b013e31829434d4 23632391","article-title":"Early versus late acute antibody-mediated rejection in renal transplant recipients","volume":"96","author":"D\u00f6rje","year":"2013","journal-title":"Transplantation"},{"key":"2026012110532022400_CR2","first-page":"277","article-title":"Plasmapheresis and intravenous immunoglobulin in the treatment and prevention of antibody mediated rejection","volume":"22","author":"Slatinska","year":"2010","journal-title":"Transplant Med"},{"issue":"5","key":"2026012110532022400_CR3","doi-asserted-by":"publisher","first-page":"1099","DOI":"10.1111\/j.1600-6143.2009.02591.x 19422335","article-title":"Comparison of combination plasmapheresis\/IVIg\/anti-CD20 versus high-dose IVIg in the treatment of antibody-mediated rejection","volume":"9","author":"Lefaucheur","year":"2009","journal-title":"Am J Transplant"},{"issue":"Suppl 4","key":"2026012110532022400_CR4","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1111\/ajt.15844 32538534","article-title":"Mechanisms of organ transplant injury mediated by B cells and antibodies: Implications for antibody-mediated rejection","volume":"20","author":"Chong","year":"2020","journal-title":"Am J Transplant"},{"issue":"12","key":"2026012110532022400_CR5","doi-asserted-by":"publisher","first-page":"1990","DOI":"10.1016\/j.ajt.2023.06.018 37414251","article-title":"Daratumumab for antibody-mediated rejection: Is it time to target the real culprit?","volume":"23","author":"de Nattes","year":"2023","journal-title":"Am J Transplant"},{"issue":"2","key":"2026012110532022400_CR6","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1097\/TP.0000000000003247 32235256","article-title":"CD38 antibody daratumumab for the treatment of chronic active antibody-mediated kidney allograft rejection","volume":"105","author":"Doberer","year":"2021","journal-title":"Transplantation"},{"issue":"13","key":"2026012110532022400_CR7","doi-asserted-by":"publisher","first-page":"1087597","DOI":"10.3389\/fimmu.2022.1087597","article-title":"Case report: Daratumumab for treatment of refractory late or chronic active antibody-mediated rejection in renal allograft recipients with high levels of de novo donor-specific antibodies","volume":"11","author":"Zhu","year":"2023","journal-title":"Front Immunol"},{"key":"2026012110532022400_CR8","doi-asserted-by":"publisher","first-page":"11771","DOI":"10.3389\/ti.2023.11771 37675269","article-title":"A novel daratumumab-based regimen for desensitization in highly HLA-presensitized patients awaiting kidney transplantation","volume":"36","author":"Zhao","year":"2023","journal-title":"Transpl Int"},{"issue":"4","key":"2026012110532022400_CR9","doi-asserted-by":"publisher","DOI":"10.1111\/tan.15458 38597238","article-title":"Daratumumab treatment in six highly sensitised solid organ transplant recipients: a case series and literature review","volume":"103","author":"Lemal","year":"2024","journal-title":"HLA"},{"key":"2026012110532022400_CR10","doi-asserted-by":"publisher","first-page":"1206","DOI":"10.1681\/ASN.2018121254 31227636","article-title":"Daratumumab 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September 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 November 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 January 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"DC received speakers\u2019 fees from GSK, Astellas, Chiesi and CareDx and research grant from CareDx, FD has received speaker\u2019s fees and research grant from CareDx and Hansa. CFL declares receiving grants throughhis institution from BMS, Janssen, and Amgen; honoraria from Amgen, Janssen, BMS, GSK and Sanofi; support forattending meetings or travel from Janssen, BMS, GSK andAmgen; and participation in data safety monitoring or ad-visory boards with Janssen, BMS, Amgen, Pfizer and Sanofi. The other authors have not conflict of interests to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"No ethical approval is needed by our Institution for the publication of Case Reports.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"All the procedures were approved by the Hospital Cl\u00ednic of Barcelona.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statement of human and animal rights"}},{"value":"The patient provided informed consent to publish his anonymized data.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent to participate"}}]}}