Do you recommend plasmapheresis prior to kidney transplantation for patients with elevated panel-reactive antibody percentages?  

No, preemptive PLEX is not necessary with a high PRA in the absence of DSA. At our center, we do monitor for emergence of DSA in our patients with the highest PRAs >98%.

We do not perform plasmapheresis pre-transplant. Some centers do. Our concern is that the focus really needs to be on stopping the anti-HLA antibody production. Pheresis removes the antibodies temporarily, but unless there is something done to mitigate antibody production, there is a high risk of a ...