Transplantation of the highly human leukocyte antigen–sensitized patient: long-term outcomes and future directions

Antibody sensitization to alloantigens of the human leukocyte antigen system is one of the greatest barriers to access and successful outcome in kidney transplantation. The number of patients with elevated panel-reactive antibodies on the waiting list continues to grow. Treatment protocols and methods to overcome or prevent antibody incompatibility have evolved and demonstrated efficacy. This review will summarize the current primary desensitization protocols, their success and outcomes, and future directions for therapy for this difficult population.