Insights from daratumumab use in highly sensitized pediatric heart transplant candidates and recipients: A single-center institutional experience and outcomes.

Allosensitization remains a significant obstacle for highly sensitized pediatric heart transplant candidates and recipients, particularly in the era of complex congenital heart disease palliations. Current desensitization strategies are limited, have variable efficacy, and lack durable response. Daratumumab, a monoclonal antibody targeting CD38 which is highly present on plasma cells and natural killer cells, is a novel and emerging option that has been successfully used for desensitization before heart transplantation in adults and to treat antibody-mediated rejection in solid organ recipients. However, there are limited data of its use in the pediatric population. We present our institution's complete experience with daratumumab in 4 highly sensitized patients with reasonable tolerability and encouraging response.