Use of Anti-μ Monoclonal Antibodies in Xenotransplantation: A Potential Approach To Overcome Vascular Rejection

In 1982, Alexandre and colleagues demonstrated that hyperacute rejection (HAR) of ABO-incompatible kidney allografts could be overcome if the recipient’s circulating preformed natural antibodies were depleted prior to transplantation. Although anti-ABO natural antibodies regain normal serum levels in the few days following transplantation, HAR usually does not occur [1, 3, 4, 36]. As first hypothesized by RH. Bach [8], the acceptance of an ABO-incompatible allograft could result from modification of endothelial cells (EC) physiological response, characteristics leading to “accommodation,” i.e., allowing the survival of the transplant in the presence of high levels of circulating IgM natural antibodies and complement, after a period of depletion