Table 2.

CD38 antibody use in solid organ transplantation.

ABMR Treatment
Réf.	Transplant	Sensitization	IS strategy	Immune event	Treatment	AntiCD38 use	Evolution	Observation
(72)	Heart + Kidney	Immunized: Preformed DSA	- Induction: ATG -Maintenance: + Tacrolimus + MMF + Steroid	-Delay post-Tx: 17 months -Clinical findings: Cardiogenic shock and acute kidney injury requiring dialysis -Anti-HLA: de novo DSA and one preformed DSA -Histology: TCMR and ABMR with PC-predominant infiltration in both transplants	Steroid pulses + ATG + Plasmapheresis + IVIG + Rituximab + Eculizumab	Daratumumab: - 16 mg/kg - 8 weekly infusions	-Clinical: Heart allograft function returned to baseline + no more need of dialysis -Anti-HLA: Dramatic decline of MFI for majority of DSA at 3 months -Histology: Significant improvement in acute lesions and the PC infiltrate significantly decreased	-20 weeks after: recurrent acute PC-rich rejection on kidney biopsy -Significant reascension of the MFI of two class 2 DSAs -New series of Daratumumab infusions with kidney allograft function improvement
(73)	Kidney	Immunized: Preformed DSA	- Induction: ? -Maintenance: + Tacrolimus + MMF + Steroid	-Delay post-Tx: 13 years -Clinical findings: Progressive graft dysfunction and proteinuria in the context of newly diagnosed myeloma -Anti-HLA: 1 DSA -Histology: chronic active ABMR	None other treatment	Daratumumab: - 16 mg/kg - 8 weekly infusions + 8 fortnightly infusions + 1 monthly infusion thereafter for 9 months	-Clinical: Stabilization of renal function and proteinuria -Anti-HLA: DSA levels became undetectable after 14 weeks -Histology: Abrogation of microvascular inflammation with a decrease of intragraft NK cells densities	-3 months after: subclinical borderline rejection - High-grade tubulitis and mild interstitial infiltrates which were dominated by T-cells -Improvement with high-dose intravenous steroid.
(85)	Kidney	Immunized: ABOi (Anti-A)	- Induction: + Basiliximab + Rituximab -Maintenance: + Tacrolimus + MMF + Steroid	-Delay post-Tx: 30 days -Clinical findings: acute kidney failure -Antibodies: rise in Anti-A titers -Histology: ABMR	Steroid pulses + ATG + Immunoadsorption + Eculizumab	Daratumumab: - 16 mg/kg - 6 weekly infusions	-Clinical: Recovering of kidney function at baseline -Anti-A: Reduction in Anti-A titers leading to discontinuation of immunoadsorption -Histology: No lesion
(86)	Heart	Immunized: History ABMR Preformed DSA	- Induction: ? -Maintenance: + Tacrolimus + MMF + Steroid	-Delay post-Tx: 13 years -Clinical findings: congestive heart failure -Anti-HLA: increase of DSA titers -Histology: ABMR	Steroid pulses + Immunoadsorption	Daratumumab: - 16 mg/kg - 8 weekly infusions + 8 fortnightly infusions + 1 monthly infusion thereafter for 9 months	-Clinical: Renal and cardiac improvement in 4 weeks -Anti-HLA: DSA titers are only slightly reduced -Histology: No lesions
(72)	Preclinical: NHP	Kidney	Daratumumab: -16 mg/kg -4 weekly infusions (8 weeks before Tx)	Plerixafor (anti‐CXCR4): -0.24 mg/kg -same frequency	Significant reduction of DSA levels and prolonged graft survival	None	Induction: anti-CD4 + anti-CD8 Maintenance: Tacrolimus + MMF + Steroid	-Delayed ABMR -DSA rebound -TCMR -Reduction of Breg and Treg -Emergence of activated T cells after kidney transplantation in the desensitization group
(72)	Clinical	Heart	Daratumumab: -16 mg/kg -8 weekly infusions	Plasmapheresis + high-dose IVIG + Rituximab	Significant and persistent reduction of DSA levels and heart transplant access at 6 months	None	NA	Died from surgical complication

ABMR, antibody mediated rejection; ATG, anti-human thymocytes globulins; DSA, donor specific antibodies; IVIG, intravenous immunoglobulins; MMF, mycophenolate mofetil; NHP, nonhuman primate; PC, plasma cells; Ref., reference; TCMR, T cell mediated rejection; Tx, transplantation.