Kidney Transplantation in Two Highly Sensitized Candidates after CAR T-Cell Therapy.

Bhoj, Vijay G; Kaminski, Mary; Zhao, Huiwu; Jackson, Kyle; Wang, Wei; Liu, Chengyang; Montgomery, Robert A; Ali, Nicole et al. · N Engl J Med · 2026

other · Level IV

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Abstract

HLA sensitization poses a major challenge to kidney transplantation for patients with end-stage kidney disease, especially for highly sensitized candidates. Attempts at antibody elimination (desensitization) have had inconsistent efficacy and have often failed to produce sustained reductions in anti-HLA antibodies in patients with the highest level of sensitization (calculated panel-reactive antibody score, ≥99.9%). We now report the results for the safety run-in cohort of a multicenter phase 1 clinical study evaluating the safety and efficacy of combined CD19-targeted and B-cell maturation antigen (BCMA)-targeted chimeric antigen receptor (CAR) T cells in eliminating the cellular sources of preformed anti-HLA antibodies (ClinicalTrials.gov number, NCT06056102). Kidney transplantation was performed in two highly sensitized candidates after desensitization with the use of dual CAR T-cell therapy.