Laboratory and clinical management of the highly sensitized organ transplant recipient.

Just a short time ago high levels of preformed lymphocytotoxic antibodies in potential renal transplant recipients constituted an almost insurmountable obstacle to finding a suitable donor. Breakthroughs in the areas of serology (e.g., removal of IgM antibodies and the use of CLL cells for serum screening), strategy (use of a calculated cumulative probability of transplantability to determine the necessary donor pool size), and therapy (the use of Staph A immunosorbent columns to remove IgG from the patient's serum and the advent of recombinant erythropoietin) are rapidly evolving to the point where there is promise of substantially improving the chances of transplanting highly sensitized patients.