**8.3. Treatment of mixed rejection**

Rejection may be mixed and have both cellular and humoral components. To date, there are no randomized control studies evaluating different therapies for the treatment of mixed rejection. Case series and small studies suggest that choosing a biologic agent that has activity against both T-cell and B-cell activity would be more favorable. Agents that have broad based activity such as Campath or Bortezomib may be better choices, than T-cell directed agents such as rATG. Plasmapharesis and IVIG may also be added therapies, especially if there is the presence of circulating donor specific antibody. Unfortunately, trials evaluating different combinations of these therapies or head to head comparison of these biologic agents do not exist.
