Approximately one third of the kidney patients that require dialysis are sensitized to human leukocyte antigens (HLA) 5. The presence of antibodies that react with a potential donor organ – i.e. donor specific HLA antibodies (DSA) – is a significant barrier to transplantation due to the risk of acute antibody mediated rejection (AMR) and hyper acute graft failure.
Sensitized patients in general have an increased waiting time for transplantation. Depending on level of HLA-immunization, some sensitized patients can be transplanted with treatment procedures using plasmapheresis or intravenous gamma globulin at some specialized clinics. The most highly sensitized patients are today very difficult to desensitize and transplant despite highest priority and the engagement of various strategies to increase the donor pool. Patients who are not possible to transplant are maintained on dialysis at a high cost, with a poor quality of life and an increased mortality.
The long-term survival rate in patients that are transplanted following desensitization is significantly better compared to patients remaining on dialysis 6. However, currently available desensitization protocols using plasmapheresis or intravenous gamma globulin are not always effective, and are time consuming, expensive, associated with serious side effects and have a significant impact on patient well being.