There is growing interest in daratumumab in the solid organ transplant realm due to the potential immunomodulatory effects on CD38 expressing cells, primarily plasma cells, as they have a key role in antibody production. In particular there is interest in use of daratumumab for desensitization and potential treatment for antibody mediated rejection. However, ongoing investigation with daratumumab has shown potential immunologic concerns in vitro, with a significant increase in cytotoxic CD4+ and helper CD8+ T cell populations in both peripheral blood (PB) and bone marrow (BM) that could lead to acute T-cell mediated rejection in the solid organ transplant patient.