Daratumumab/Eculizumab/Steroids: Lack of efficacy.

A 41-year-old woman with alcoholic cirrhosis underwent an ABO incompatible liver transplant and developed acute antibody mediated rejection. She was treated with daratumumab, eculizumab, and steroids, but the treatment was unsuccessful, and she continued to have de novo donor specific antibodies. As a result, she received off-label imlifidase followed by therapy with immune globulin and rituximab, which successfully resolved the rejection. This case highlights the challenges and potential solutions in treating antibody mediated rejection after liver transplantation. [Extracted from the article]