Severe Flash Pulmonary Edema Following Rituximab and Daratumumab Infusion for Post‐Transplant Antibody‐Mediated Rejection

BACKGROUND: Monoclonal antibodies, including rituximab and daratumumab, play a pivotal role in the management of antibody-mediated rejection (AMR) following solid organ transplantation. Although generally effective, these agents can induce rare but potentially fatal complications. METHODS: We present two cases of post-transplant AMR in which patients developed fatal complications following the administration of rituximab and daratumumab. Both cases were analyzed in detail to assess the sequence of clinical events and potential underlying mechanisms. RESULTS: Both patients developed severe flash pulmonary edema shortly after receiving the monoclonal antibody therapy. This was followed by rapid clinical deterioration, including multiorgan failure. The clinical features and biopsy findings were consistent with cytokine release syndrome as the probable trigger for these complications. CONCLUSION: Early recognition, prompt discontinuation of the offending agent, and targeted therapeutic interventions are crucial to improving outcomes in these life-threatening scenarios.