Immune system modulation in the highly sensitized transplant candidate.

Heart transplantation can be a lifesaving option for patients with end-stage heart failure. However, implanting recipients with an organ or tissue from a donor presents immunologic challenges. Sensitized recipients are at risk for hyperacute rejection because of the presence of preformed antibodies. Immune modulation with cyclophosphamide, plasmapheresis, and intravenous gamma globulin are methods used to desensitize transplant candidates with preformed anti-HLA antibodies to achieve successful transplantation.