Modern approaches to incompatible kidney transplantation

Figure 1 Desensitization protocols. A: The NIH Ig02 trial administered intravenous immunoglobulin (IVIG) in four monthly doses for patients awaiting a living or deceased donor transplant. This was followed by a living or deceased donor transplant once an acceptable crossmatch was achieved; B: Johns Hopkins University used a combination plasmapheresis (PP) with low-dose cytomegalovirus immune globulin following each PP session. The number and frequency of the PP sessions is dependent on the donor specific antibody titer. A living donor transplant occurs when an acceptable crossmatch is achieved. Additional sessions of PP/IVIG are administered after transplant; C: A modified protocol combining IVIG and rituximab was developed at Cedars-Sinai Medical Center. Two doses of IVIG are administered one month apart with one dose of rituximab given in between. A deceased or living donor transplant then takes place when an acceptable crossmatch is obtained.