Table 2.

Therapeutic options for acute AMR

Therapy	Studies	Mechanism of Action	Effectiveness
Plasmapheresis	Bonomini et al. (1985)[37] Kirubakaran et al. (1981)[38] Allen et al. (1983)[39] Blake et al. (1999)[40] Stegall et al. 2006[41]	Physical removal of antibody	Temporarily effective at reducing antibody level depending on continued antibody production.
Intravenous Immunoglobulin (IVIG)	Glotz et al. (1993)[42] Tyan et al. (1994)[43] Jordan et al. (1998)[11] Casadei et al. (2001)[13] Tyan et al. 1994 [43] Stegall et al. 2006 [41] Lafaucheur et al. (2009)[44]	Multiple immunomodulatory actions	Variable efficacy
Splenectomy	Locke et al. 2007 [17] Tzvetanov et al. 2012[18]	Reduce B-cell and Plasma Cell burden	Variable efficacy
Rituximab	Kaposztas et al. 2009[45] Lafaucheur et al. 2009 [44]	CD 20+ inhibitor leading to reduction in B-cells	Variable efficacy
Bortezomib	Everly et al. 2008[26] Walsh et al. 2010[27] Wong et al. 2010[28]	Proteasome inhibitor leads to plasma cell apoptosis	Variable efficacy
Eculizumab	Stegall et al. 2011[3]	Terminal complement (C5) inhibitor	Very effective at inhibiting acute AMR, but does not prevent chronic AMR. Expensive.