Table 1. Immunosuppressive regimen.
| Agent | Dose | Timing | Route | Pre-treatment | Purpose |
|---|---|---|---|---|---|
| Induction | |||||
| Anti-CD20 | 19 mg kg−1 | Days −7, 0, 7 and 14 | i.v. infusion | Solu-Medrol, Benadryl, H2 blocker | To deplete B cells |
| ATG | 5 mg kg−1 | Days −2, and −1 | i.v. infusion | Solu-Medrol, Benadryl, H2 blocker | To reduce number of T cells |
| Anti-CD40 (clone 2C10R4) | 50 mg kg−1 for 100 days–1 year, then slowly tapered off | Slow i.v. infusion | None | Co-stimulation blockade. Suppression of both B- and T-cell response | |
| CVF | 50–100 U kg−1 | Days −1, 0 and 1 | i.v. | None | To inhibit complement activity |
| Maintenance | |||||
| Anti-CD40 (clone 2C10R4) | 10–50 mg kg−1* | Weekly | Slow i.v. infusion | None | Co-stimulation blockade. Suppression of both B- and T-cell response |
| MMF | 20 mg kg per 2 h | BID, daily | i.v. infusion | None | BID daily |
| Solu-Medrol | 2 mg kg−1 | BID tapered off in 7 weeks | i.v. | None | Suppress inflammation |
| Aspirin | 81 mg | Oral | None | Prevent platelet aggregation | |
| Heparin | 50–400 U h−1 | Continuous | i.v. infusion | None | Maintain ACT 2 × normal and prevent inflammation |
| Supportive | |||||
| Ganciclovir | 5 mg kg−1 per day | Daily | i.v. infusion | For CMV prophylaxis | |
| Cefazolin | 250 mg | Daily for 7 days and whenever needed | i.v. | None | Antibiotic cover |
| Epogen | 200 U kg−1 | Day −7 to 7 then weekly | i.m. or i.v. | None | To increase haematocrit |
BID, twice daily; CMV, Cytomegalovirus; CVF, cobra venom factor; i.m., intramuscular; i.v., intravenous.
*Anti-CD40 antibody dose was reduced either from 50 to 25 mg kg−1 on day 100 (n=2) or completely tapered off starting from day 365 (n=2).