Figure 1.

A simplified, conceptual diagram of the targets of current therapeutic modalities for pre-transplant desensitization and treatment of antibody mediated rejection. The dashed arrows indicate the sites of action for the therapeutics. Rituximab exerts its effects on CD20+ B-cell lines with absence of activity against pro-B cells and plasma cells and questionable activity against memory B cells. Bortezomib targets plasma cells which elaborate the antibodies implicated in donor-specific antibodies and antibody-mediated rejection while the antibodies produced are targeted with intravenous immunoglobulin (IVIG) and plasmapheresis (PP).