MedUni Vienna: Kidney transplant despite poor initial conditions through a new drug that sustainably reduces immune response against the donor organ
An international research team led by the Medical University of Vienna has reported a new treatment strategy that enabled a kidney transplant in a patient who previously had virtually no chance of receiving a compatible donor organ. The study demonstrates that the cancer drug teclistamab can substantially and sustainably reduce antibodies directed against donor organs, potentially opening new perspectives for highly sensitised transplant patients. The findings were published in the New England Journal of Medicine.
Teclistamab is currently approved for the treatment of multiple myeloma. The drug selectively eliminates antibody-producing cells in the blood and bone marrow. Researchers at the Medical University of Vienna investigated whether this mechanism could also be used to reduce harmful antibodies that prevent successful organ transplantation.
Kidney transplantation after prolonged treatment
The treatment was applied in a 37-year-old dialysis-dependent patient who had developed severe HLA sensitisation following two previous kidney transplants. As a result, the patient's immune system produced antibodies against nearly all potential donor organs, resulting in a calculated probability of virtually zero for finding a compatible kidney. The patient had remained on the transplant waiting list for more than twelve years.
After 31 weeks of treatment with teclistamab, antibody levels against donor tissue antigens were substantially and sustainably reduced. As additional donor organs became immunologically acceptable during treatment, a suitable kidney was eventually identified and successfully transplanted. According to the research team, the patient has excellent kidney function following transplantation and no longer requires dialysis.
Potential paradigm shift in transplant medicine
Between 20 and 30 percent of patients waiting for a kidney transplant are affected by significant HLA sensitisation, and current desensitisation strategies generally provide only limited and temporary reductions in antibody levels. In contrast, teclistamab directly targets antibody-producing cells, resulting in a more sustained suppression of the immune response.
The researchers suggest that this approach could substantially improve transplant opportunities for patients with particularly unfavourable immunological profiles and may represent a new therapeutic strategy in transplant medicine.
Further clinical studies planned
Beyond kidney transplantation, the detailed immunological findings indicate that the treatment approach may also have potential applications in xenotransplantation using genetically modified pig organs, blood-group-incompatible transplantation and the treatment of antibody-mediated rejection following transplantation. Before the therapy can be introduced into routine clinical practice, however, larger clinical studies are required to evaluate its safety and effectiveness. A clinical study investigating this treatment strategy is already being planned at the Medical University of Vienna.