Anti-CD38/Anti-CD20 Rescue Therapy for Posttransplant Recurrent FSGS
- Journal
- Kidney international reports (Q1)
- Published
- 16 June 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 4, Very Low (CEBM 4)
- Authors
- Juliette Leon, Elise Ducrocq, Marie-Camille Lafargue, Dominique Bertrand, Lucie Maigret, Mohamad Zaidan, et al.
- PMID
- 42571438
- DOI
- 10.1016/j.ekir.2026.106668
Why clinicians should know about it
- Picked for Nephrology (paper of the day, 10 August 2026).
- Picked for Transplantation (paper of the day, 10 August 2026).
Abstract
INTRODUCTION: Recurrent focal segmental glomerulosclerosis (FSGS, rFSGS) is a severe complication after kidney transplantation, often resistant to standard therapies and requiring prolonged apheresis. Combined depletion of plasma cells (anti-CD38) and B cells (anti-CD20) has emerged as a potential strategy; however, multicenter real-world data integrating clinical, biological, and histological characterization remain limited. METHODS: We retrospectively studied 17 kidney transplant recipients with rFSGS treated with daratumumab (anti-CD38) administered after and/or in combination with anti-CD20 therapy across 12 French centers. Patients were clinically and histologically characterized at treatment initiation. Clinical response, safety, and longitudinal antinephrin antibody trajectories were assessed. RESULTS: Median time from recurrence to daratumumab initiation was 5 months. All patients had previously received B-cell-depleting therapy. After the first daratumumab course (1-8 injections), 7 patients (41%) achieved complete remission (CR) and 4 (24%) achieved partial remission (PR), allowing discontinuation of apheresis in all responders. Median response time was 24 days. During a median follow-up of 8 months, 3 responders relapsed but regained remission after retreatment. Median proteinuria decreased from 3.9 g/g to 1.4 g/g at 1 month (P = 0.029). Among 11 patients tested, 3 had positive antinephrin antibodies. Two patients showed marked posttreatment declines paralleling clinical response, whereas 1 did not. Treatment was well-tolerated. CONCLUSION: In this multicenter real-world cohort, combined plasma cell and B-cell depletion was associated with meaningful remission rates in refractory rFSGS and was accompanied by dynamic changes in antinephrin antibodies in selected cases. Prospective trials are warranted to define optimal patient selection and dosing, and to clarify its place in therapy.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.