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Stegall MD, Diwan T, Raghavaiah S, Cornell LD, Burns J, Dean PG, et al. Terminal Complement Inhibition Decreases Antibody-Mediated Rejection in Sensitized Renal Transplant Recipients. Am J Transplant 2011; 11: 2405–2413. DOI: 10.1111/j.1600-6143.2011.03757.x

This note is to clarify the use of intravenous immunoglobulin (IVIG) in our recent study using the terminal complement inhibitor eculizumab to prevent early antibody-mediated rejection (AMR) in sensitized renal allograft recipients. Since IVIG is thought to possibly block complement activity, it is important to clarify its use in this study. Low dose IVIG (10 mg/kg) was given after each plasma exchange in both groups (those historical control patients treated with plasma exchange alone and those treated with eculizumab). In both groups, pretransplant plasma exchange was performed in the same number of patients and for similar duration. As outlined in the manuscript, posttransplant plasma exchange was performed primarily in the control group. Thus, patients receiving eculizumab actually received less IVIG and most received no posttransplant IVIG while receiving eculizumab. Despite receiving less IVIG, the eculizumab-treated patients showed a significant reduction in the incidence of AMR in the first 90 days after transplantation.