{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T12:34:15Z","timestamp":1792067655176,"version":"4.4.0"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T00:00:00Z","timestamp":1768867200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background.<\/jats:title>\n                    <jats:p>Focal segmental glomerulosclerosis (FSGS) recurrence after kidney transplantation is a leading cause of allograft failure and remains difficult to treat. Standard therapies, including plasma exchange (PEX) and rituximab, are often ineffective and poorly tolerated. Growing evidence implicates immune-mediated circulating factors, such as IgG and IgM autoantibodies, in disease pathogenesis. Given the central role of memory B cells and plasma cells in antibody production, we tested the safety\/efficacy profile of a combined B-cell and plasma cell\u2013depleting approach with rituximab and daratumumab in patients with posttransplant FSGS recurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods.<\/jats:title>\n                    <jats:p>This is a retrospective analysis of a multicenter, international cohort of sixteen patients (median age 37 y) with biopsy-proven FSGS recurrence posttransplant who received anti-CD20 plus anti-CD38 monoclonal antibodies or anti-CD38 alone. The majority of patients were resistant to common therapies, including rituximab and PEX.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results.<\/jats:title>\n                    <jats:p>The treatment achieved complete or partial remission in 5 and 11 patients, respectively. Five experienced proteinuria relapse, and 4 responded to repeated daratumumab alone. At the last follow-up (median 11 [2\u201318] mo), 13 patients are still in remission and PEX was discontinued in all but 3 cases. Overall, kidney function improved after treatment, and no severe acute or chronic adverse events were reported. Serological analysis revealed a significant decline in IgM, but not in IgG, after treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions.<\/jats:title>\n                    <jats:p>Despite the retrospective, nonrandomized design, the temporal association between treatment and remission supports an effect of anti-CD38 monoclonal antibody alone or in combination with anti-CD20. Treatment is safe and may confer enhanced efficacy over standard approaches. Prospective, mechanistic studies are warranted to validate these findings and delineate the immunopathogenesis of FSGS recurrence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/txd.0000000000001908","type":"journal-article","created":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T17:00:41Z","timestamp":1768928441000},"page":"e1908","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":6,"title":["Combined Anti-CD20\/Anti-CD38 Therapy in Posttransplant Focal Segmental Glomerulosclerosis Recurrence: A Retrospective, International, Multicenter Study"],"prefix":"10.1097","volume":"12","author":[{"given":"Paolo","family":"Cravedi","sequence":"first","affiliation":[{"name":"Department of Medicine, Transplantation Research Center, Icahn School of Medicine at Mount Sinai, New York, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umberto","family":"Maggiore","sequence":"additional","affiliation":[{"name":"Nephrology Unit, University Hospital of Parma, Parma, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Mortari","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Transplantation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Alberici","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Dialysis, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili de Brescia, Brescia, Italy."},{"name":"Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaetano","family":"La Manna","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy."},{"name":"Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelson","family":"Goes","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Bouvier","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Transplantation, University of Caen, Caen, France."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgia","family":"Comai","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy."},{"name":"Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali Poyan","family":"Mehr","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Micaela","family":"Gentile","sequence":"additional","affiliation":[{"name":"Nephrology Unit, University Hospital of Parma, Parma, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Palmisano","sequence":"additional","affiliation":[{"name":"Nephrology Unit, University Hospital of Parma, Parma, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Gessaroli","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy."},{"name":"Division of Nephrology, Department of Medicine, University of Illinois College of Medicine, Chicago, IL."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Barbuto","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy."},{"name":"Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Caridi","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Transplantation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina","family":"Bigatti","sequence":"additional","affiliation":[{"name":"Department of Medicine, Transplantation Research Center, Icahn School of Medicine at Mount Sinai, New York, NY."},{"name":"Nephrology, Dialysis and Transplantation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Magnasco","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Transplantation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Bossini","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Dialysis, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili de Brescia, Brescia, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xhuliana","family":"Kajana","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Transplantation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnese","family":"Spennacchio","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Transplantation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Gallon","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, University of Illinois College of Medicine, Chicago, IL."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gian Marco","family":"Ghiggeri","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Transplantation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavio","family":"Vincenti","sequence":"additional","affiliation":[{"name":"Kidney Transplant Service, Department of Medicine, University of California-San Francisco, San Francisco, CA."},{"name":"Kidney Transplant Service, Department of Surgery, University of California-San Francisco, San Francisco, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank E.","family":"Hullekes","sequence":"additional","affiliation":[{"name":"Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohan V.","family":"Mehta","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Hypertension and Renal Transplantation, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo V.","family":"Riella","sequence":"additional","affiliation":[{"name":"Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico E.","family":"Verrina","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Transplantation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Angeletti","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Transplantation Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,1,20]]},"reference":[{"key":"R1-20260123","doi-asserted-by":"crossref","first-page":"247","DOI":"10.2215\/CJN.08970719","article-title":"Recurrence of FSGS after kidney transplantation in adults.","volume":"15","author":"Uffing","year":"2020","journal-title":"Clin J Am Soc Nephrol"},{"key":"R2-20260123","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1111\/j.1600-6143.2009.02580.x","article-title":"Intensive and prolonged treatment of focal and segmental glomerulosclerosis 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syndrome.","volume":"321","author":"Trachtman","year":"2021","journal-title":"Am J Physiol Renal Physiol"},{"key":"R6-20260123","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1016\/j.ajt.2023.12.010","article-title":"Efficacy of combined rituximab and daratumumab treatment in posttransplant recurrent focal segmental glomerulosclerosis.","volume":"24","author":"Angeletti","year":"2024","journal-title":"Am J Transplant"},{"key":"R7-20260123","doi-asserted-by":"crossref","first-page":"1896","DOI":"10.1016\/j.ajt.2024.06.010","article-title":"Rescue with obinutuzumab and daratumumab as combined B cell\/plasma cell targeting approach in severe posttransplant focal segmental glomerulosclerosis recurrence.","volume":"24","author":"Randone","year":"2024","journal-title":"Am J Transplant"},{"key":"R8-20260123","doi-asserted-by":"crossref","first-page":"e14544","DOI":"10.1111\/petr.14544","article-title":"Successful global anti-B-cell strategy with daratumumab in a patient with 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