Treatment of Biopsy-Proven Acute Antibody-Mediated Rejection Using Thymoglobulin (ATG) Monotherapy and a Combination of Rituximab, Intravenous Immunoglobulin, and Plasmapheresis: Lesson Learned from Primary Experience.

All 5 AMR cases occurred in patients who received renal transplants from HLA highly mismatched DCD donors. Both ATG and rituximab had a significant depleting effect on B cells, but their effects on DSA were not ideal. Mild or moderate acute AMR was ameliorated but not cured by ATG monotherapy. For AMR patient with severe biopsy-proven graft injuries, B cell- and antibody-targeted therapies were not successful since they do not have immediate inhibitory or blocking effects on antibody-caused tissue injury. Therefore, anti-inflammatory, anti-coagulation and complement blockage agents should also be considered as part of an AMR treatment regimen in addition to strategies to remove or block DSA and to inhibit antibody production.