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Highly Sensitised Transplant Candidate — ESENeph MCQ

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HardTransplantationHighly Sensitised Transplant CandidateESENeph

A 50-year-old woman with ESKD awaiting transplant has a panel reactive antibody (PRA/cRF) of 95%. She has had two previous transplants and multiple blood transfusions. What strategy can improve her chances of finding a compatible donor?

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Correct answer: B — HLA-incompatible transplant with desensitisation

Highly sensitised patients (PRA >85%) have significantly reduced access to compatible organs. Options include the national kidney sharing scheme (prioritisation for highly sensitised patients), paired/pooled kidney exchange, and HLA-incompatible transplantation with desensitisation protocols (plasma exchange, IVIg, Rituximab). In the UK, the NHSBT allocation algorithm prioritises highly sensitised patients. Acceptable mismatch programmes help identify permissible HLA antigens.

Reference: NHSBT 2023 – Kidney Allocation Policy; BTS 2018 – Antibody-Incompatible Transplantation