I have a question regarding my wife’s transplant. She had a blood transfusion and now with her PRA’s at 98 percent. She was told that the living donor could not donate. What are the chances of Plasmapheresis and are they expensive? John’s Hopkins says incompatible transplants are okay. What do you think?

This is a complex question and I do not have easy answers.  If your wife has 98% panel reactive antibodies (PRA’s), it means that it will be difficult to find a matching kidney for her because she is likely to react with 98% of the population of donors that might be offered to her for transplantation.  Plasmapheresis can be done for preparation for a mismatched kidney, but is very expensive and still can result in failure of the transplant.  Your wife will have to be evaluated by the transplant team.  Living donor kidneys could be a consideration but again is associated with very high risk of failure.  I suggest she continue to work with the transplant team to come up with options for her to pursue.  John Hopkins transplant center has a great deal of experience with mismatched kidneys and high risk transplants, but I would again emphasize the risk will be greater than if she did not have these highly reactive PRA’s.  In some instances, donor specific antibodies (DSA’s) can be measured so as to know exactly which people and donors she would likely react to.  This is a complex area that must be discussed with her transplant physicians.

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