Apples, oranges, and anything in between: In search of the best desensitization therapy

Patients exhibiting high percent calculated panel reactive antibodies (cPRA) have limited access to transplantation. A sliding scale prioritization scheme was introduced to the allocation system in December of 2014 to particularly support patients with a cPRA ≥98. While many highly sensitized patients benefited from the change, patients with cPRA >99.9 remain disadvantaged and may benefit from desensitization1 . Other highly sensitized patients with an HLA incompatible living donor may also benefit from combining kidney paired donation and desensitization. Thus far, several desensitization approaches have been reported, with equivocal results.