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(73) - Favorable Use of Daratumumab in Highly Sensitized Pediatric Heart Transplant Candidates and Recipients
Abstract   Peer reviewed

(73) - Favorable Use of Daratumumab in Highly Sensitized Pediatric Heart Transplant Candidates and Recipients

M. Husain, L.C. Reardon, N.J. Halnon, R.S. Khan, A. Fan, M.M. Si, R.M. Biniwale and J.C. Alejos
The Journal of heart and lung transplantation, Vol.43(4 Suppl), pp.S44-S44
04/2024
DOI: 10.1016/j.healun.2024.02.087

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Abstract

Introduction: Daratumumab has been used to treat AMR and for desensitization prior to heart transplantation in adults. There is limited data of its use in pediatrics. We present 3 cases that highlight its favorable use. Case Report: Case 1: A now 21 y/o with OHT due to heart failure s/p biventricular repair of Shone's Complex including a valved LV to DAo conduit. He was heavily sensitized pre-transplantation and underwent aggressive desensitization with therapeutic plasma exchange (TPE), IVIG, Bortezomib, Rituximab and Tocilizumab, without significant reduction in titers, followed by Daratumumab with a robust response. Post-transplant, he had rebound of DQ6 to >20k MFI with histopathologic AMR prompting removal of the retained conduit and treatment with Daratumumab resulting in reduction of DQ6 to <5,000 MFI. Case 2: 4 y/o listed for OHT s/p failed staged II palliation for HLHS. She was sensitized to both class I and II HLA antibodies (Ab), including C1q+ Abs, with a cPRA of 100% at listing. She was treated with IVIG and Rituximab as an outpatient. During an admission for refractory arrhythmias with resultant cardiac arrest requiring VA-ECMO and placement of an epicardial pacemaker, she underwent TPE and initiation of Daratumumab with a significant reduction of titers and lower cPRA. Case 3: 9 y/o listed for heart-kidney transplant with a history of repaired TOF/PA with MAPCAS, DiGeorge syndrome, ESRD requiring dialysis, Milrinone for HFrEF, and significant transfusion requirement for severe epistaxis from thrombocytopenia related to Evans syndrome. As a result, both class I and II HLA Abs peaked with >20k MFI and a cPRA of 100%. Daratumumab was initiated after fair trials with TPE, IVIG, and Rituximab. She currently has downtrending titers on biweekly dosing. All tolerated the infusions well save for transient neutropenia in the last patient. Summary: Our cases demonstrate the potential efficacy of Daratumumab to treat AMR and use as desensitization therapy in the pediatric heart transplant population.

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