B272 - The Role of Anti-Nephrin Antibodies and Daratumumab in Recurrent Focal Segmental Glomerulosclerosis: A Case Series of Four Patients

View session detail

Author Block: W. Rojas Gimenez¹, M. Bissonnette², T. Blydt-Hansen³, C. Mammen³, A. Weins⁴, A. Cunningham¹, E. Hendren¹, ¹University of British Columbia, Vancouver, BC, Canada, ²Pathology, University of British Columbia, Vancouver, BC, Canada, ³BC Children, University of British Columbia, Vancouver, BC, Canada, ⁴Brigham and Women's Hospital, Boston, MA
*Purpose: Recurrent focal segmental glomerulosclerosis (rFSGS) following kidney transplantation leads to poor long-term outcomes including graft loss. The presence of circulating factors, such as anti-nephrin antibodies, may be implicated in disease recurrence. This case series aims to characterize and compare transplant outcomes in patients with and without anti-nephrin antibodies, as well as the therapeutic role of Daratumumab.
*Methods: This is a case series of three adult and one pediatric patients who developed rFSGS after kidney transplantation. Clinical data was obtained from chart review. Anti-nephrin antibodies were obtained from frozen samples archived before transplant and at the time of transplant measured with ELISA at Brigham and Women’s Hospital, Boston, MA. All patients received induction with Thymoglobulin or Basiliximab and were maintained on Tacrolimus, Mycophenolate and systemic corticosteroids as per center protocol.
*Results: The patients with anti-nephrin antibodies were younger at time of transplant and disease onset and had a faster recurrence of FSGS. There was more treatment resistance and less likelihood to develop a complete remission. Three of four patients were treated with plasmapheresis (PLEX) and Rituximab; among them, one also received Ruxolitinib, and another received Daratumumab. One patient received Rituximab and Daratumumab without PLEX . While three patients achieved partial remission, two continued on PLEX, and one did not experience remission and underwent graft nephrectomy.
*Conclusions: rFSGS following kidney transplantation remains a major concern, and may be earlier and more aggressive in patients with pre-transplant anti-nephrin antibodies. Daratumumab may offer a therapeutic benefit irrespective of anti-nephrin antibody status. Understanding the clinical differences between anti-nephrin positive and negative patients could help improve management and guide decision-making for repeat transplants.