Overcoming preexisting alloantibody in renal transplantation—improving outcomes while reducing needs and costs

In this week's journal, Axelrod and colleagues examine costs incurred by various US centers undertaking Incompatible Live-Donor Kidney Transplantation (ILDKT) - living donor renal transplantation in the presence of preformed antibody (ies) directed against donor HLA (DSAb) [1]. As expected, cost increased as the immunological barrier intensified (as defined by solid phase and cell based assays). While certain aspects of cost recovery are specific to US health care, effectively managing humoral allo-immunity is important to all transplant clinicians, with little progress despite nearly 2 decades of ILDKT [2, 3]. This article is protected by copyright. All rights reserved.