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 |
