Understanding Desensitization (Solid Organ Transplant)
Transplant rates are extremely low in patients with high levels of human leukocyte antigen (HLA) antibodies. These antibodies are a key part of the body’s immune response and target foreign substances. In this case, they attack the transplanted organ, leading to rejection. HLA antibodies result from previous transplants, blood transfusions, and/or pregnancy. Thus, female patients are more likely to be affected than males. Panel Reactive Antibody (PRA) is a blood test that measures the presence of HLA antibodies and is checked prior to transplantation. The higher the PRA, the more likely the organ will be rejected. Those who are highly sensitized (PRA level >80%) are likely to remain on organ wait lists for extended periods. Desensitization is the process of decreasing antibodies the organ recipient may have that increases the risk of rejection after transplant.
Treatment of Desensitization (Solid Organ Transplant)
Desensitization therapy may vary depending on the transplant center, and may involve steroids, plasmapheresis, immune globulin therapy, and/or other drugs. Immune globulin therapy, administered into the blood stream intravenously (IVIG), is used to suppress the immune response and is known as immunomodulation. The mechanism of action of IVIG in this manner is not clearly understood. IVIG is essentially antibodies from a variety of human donors. This large variety of antibodies is thought to suppress the immune response, thereby decreasing antibody production and ultimately lowering PRA levels. Plasmapheresis (also known as apheresis, plasma exchange, or “plex”) is a medical procedure where a device separates whole blood into the cellular components and plasma. The plasma is then discarded and replaced with a colloid fluid, combined back with the cellular components, and returned to the same patient.
Resources for people undergoing a kidney transplant:
- National Kidney Foundation
- United Network for Organ Sharing
- Resources for Patients, Caregivers, and the Public
- Kidney School
- HelpHopeLive
Reference:
- Jordan SC, Vo A, Tyan D, Toyota M. Desensitization therapy with intravenous gammaglobulin (IVIG): applications in solid organ transplantation. Trans Am Clin Climatol Assoc. 2006;117:199-211; discussion 211. PMID: 18528474; PMCID: PMC1500934.
- Kidney transplantation in adults: HLA desensitization (Last accessed October 28, 2025) | UpToDate
Last reviewed 12/16/2025
