CAR T cells for HLA desensitization: a new era in kidney transplantation

Description

Peter R Mertens, Eugen Feist, and Dimitrios Mougiakakos comment on a New England Journal of Medicine study that used CAR T-cell therapy to make kidney transplants possible for two patients. Both patients' immune systems rejected nearly every donor. Such patients carry levels of anti-HLA antibodies from past exposure, and standard antibody-lowering treatments rarely last, because the cells making the antibodies survive.

The trial gave each patient their own engineered T cells aimed at two targets covering the antibody-producing cell family, in a phase one safety run-in. Antibody levels fell enough for both to receive transplants, the first proof that this approach can desensitise. The commentators place the result against the maths of waiting lists, where some patients match one donor in fifty thousand. They note open questions on targets, durability, and safety, while calling the concept an era if later trial stages hold up.

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Source: https://europepmc.org/article/MED/PMC13623966