**2. HLAi renal transplantation**

Antibodies against HLA are critical immunologic barriers to successful transplantation. The formation of HLA antibodies before or after transplantation is associated with poor graft and patient outcomes [1].

In the United States, 35% of waitlisted renal transplant candidates are sensitized. Fifteen percent of them are highly sensitized with calculated panel reactive antibodies (cPRA) >80% [2]. HLA sensitization restricts the number of compatible donors, thus reducing the chances of finding an acceptable HLA phenotype donor. Currently, only 6.5% of highly sensitized patients (cPRA > 80%) receive renal transplants each year [3]. Data from the United Network of Organ Sharing (UNOS) show longer waiting time for transplantation in sensitized individuals [4] (**Table 1**). Furthermore, sensitization increases the risk of hyper-acute, accelerated, and chronic graft rejection post-transplantation.

Highly sensitized individuals have three options to access renal transplantation, i.e., either,


Desensitization reduces the cPRA by reducing DSA levels and thus increases the chances of getting an organ from a compatible donor. Furthermore, it lowers the risk of hyperacute rejection post-transplantation.
