Desensitisation strategies in high-risk children before kidney transplantation.

Background: Transplantation is the preferred modality for renal replacement therapy in children. With increasing rates of re-transplantation within the paediatric population, there are more sensitised children on waiting lists. One issue with developing strategies to treat these children is the number of different definitions of sensitisation. and we would therefore recommend an immunological risk stratification approach.Methods: We discuss methods of sensitisation prevention, assessment and management, including paired exchange programmes and desensitisation protocols.Results: There are limited published evidence-based data for desensitisation in adults and none in children; thus, we present information on the available therapies currently in use.Discussion: Further research is required to investigate strategies which prevent sensitisation in children, including the healthcare utility of incorporating epitope-based matching into organ allocation algorithms. Controlled studies are also needed to establish the most appropriate desensitisation regimen(s). [ABSTRACT FROM AUTHOR]