Table 2.

Desensitization therapies in kidney transplantation.

Drug class	Name	Mechanism of Action	Previous and ongoing studies	Key Features
Plasmapheresis	NA	Removal of circulating immunoglobulin	Stegall et al. (28)
Intravenous Immunoglobulin	NA	Exact mechanism unknown. Multiple Immunomodulatory mechanisms.	Glotz et al. (34) Jordan et al. (35) Stegall et al. (28)
Anti-CD 20 monoclonal antibodies	Rituximab	Depletes B cells	Jordan et al. (36) Vo et al. (31) Jackson et al. (37)
	Obinutuzumab		Redfield et al. (38)	3rd generation anti-CD20 dependent on ADCC. Used in for relapsed hematologic malignancies.
Proteosome inhibitors	Bortezomib	Accumulation of unwanted cellular protein and apoptosis.	Woodle et al. (39) Moreno Gonzalez et al. (40)	Reversible proteasome inhibitor
	Carfilzomib		Tremblay et al. (41)	Irreversible proteasome inhibitor. Less neurotoxicity than bortezomib.
	Ixazomib		Ongoing ClinicalTrials.gov Identifier: NCT03213158	First oral proteasome inhibitor
Anti-CD38 monoclonal antibodies	Daratumumab	Depletes plasma cells	Kwun et al. (42)	Studied in nonhuman primate model and was associated with increased in T cell mediated rejection.
	Isatuximab		Ongoing ClinicalTrials.gov Identifier: NCT04294459
Cysteine protease	Imlifidase	Cleaves heavy chains of human IgG (all subclasses) and eliminates IgG effector functions	Jordan et al. (43) Jordan et al. (44)	Rebound of DSA at Day 7. Retreatment with imlifidase often ineffective because of the development of neutralizing antibodies.
Interleukin-6 Blockade	Tocilizumab	IL-6 receptor inhibitor	Vo et al. (45)
Complement inhibitors*	Eculizumab	Terminal complement blockade to protect against antibody mediated rejection.	Stegall et al. (46) Marks et al. (47) Glotz et al. (48)

*Does not deplete antibody and therefore not a “desensitization” agent.