How to Approach HLA Sensitization in Heart Transplant Candidates

• HLA sensitization in heart transplant candidates is increasingly common due to use of mechanical circulatory support and transplantation of candidates with adult congenital heart disease and is associated with increased rejection, allograft vasculopathy, and mortality post-transplantation. • Heart transplant candidates can be risk stratified by assessment of the identity and strength of anti-HLA antibodies, which form the basis of the cPRA. • The cPRA is used to guide desensitization and peritransplant immunosuppression strategies as well as the need for a prospective vs virtual crossmatch.