Novel Therapeutic Approach for Solid Organ Transplantation-associated GVHD

In this case report, 2 children with end-stage renal disease and severe primary immune deficiency (Schimke syndrome) who developed severe steroid-resistant acute graft-versus-host disease (GVHD) along with full and sustained donor T cell chimerism after isolated kidney transplantation, is presented. GVHD occurs after solid organ transplant and is often lethal.

After receiving appropriate approval, the authors treated the patients with a strategy based on adoptive transfer of anti-HLA donor-specific antibodies (DSAs) through the transfusion of highly selected plasma. More than 3800 registered blood donors with known anti-HLA sensitization were searched, and the treatment was well tolerated. The authors noted that the DSA-rich plasma did not induce antibody-mediated rejection of the renal allografts.

Symptoms of acute GVHD were resolved in one child and the authors concluded that, “This report provides a proof-of-concept for a highly targeted novel therapeutic approach for solid organ transplantation-associated GVHD.”

Reference

Zuber J, Boyer O, Neven B, et al. Donor-targeted serotherapy as a rescue Therapy for steroid-resistant acute GVHD after HLA-mismatched kidney transplantation. AM J Transplant. 2020; [Online ahead of print]. DOI: 10.1111/ajt.15827.