Evolution of anti-MICA antibodies after imlifidase infusion for a high immunological risk kidney transplantation

Abstract

Imlifidase is an endopeptidase known for cleaving anti-Human Leucocyte Antigen donor-specific antibodies (DSA) to allow high-risk kidney transplantation. However, it lacks comprehensive data regarding its effect on alloantibodies targeting other histocompatibility antigens, such as Major Histocompatibility Complex class I chain-related protein A (MICA). This study describes the dynamics of anti-MICA antibodies following imlifidase administration in a kidney transplant recipient with anti-MICA*002 preformed DSA. Imlifidase induced a notable reduction in anti-MICA antibodies, followed by a rebound of the anti-MICA DSA after 14 days. Subsequent to early antibody-mediated rejection, the combination of immunoadsorption and daratumumab infusion proved effective in removing all anti-MICA antibodies at day 45 after transplantation. These findings shed light on the management of anti-MICA antibodies, an area still lacking consensus in current clinical practice. This research underscores the significance of imlifidase in addressing pretransplant anti-MICA and other antibodies directed against non-HLA targets, extending its therapeutic utility in kidney transplantation.

Keywords: Antibody-mediated rejection; DSA; Imlifidase; Kidney transplantation; MICA.