Kidney Transplantation in Highly Sensitized Persons after CAR T-Cell Therapy

To the Editor: Clinical decision making in transplantation requires balancing treatment-related risks against expected benefits. Accordingly, the intensity of desensitization therapy and its inherent risks should be proportional to the immunologic challenge. Although both patients described by Bhoj et al. (June 4 issue) 1 had broad sensitization to HLA antigens, chimeric antigen receptor (CAR) T-cell therapy achieved sustained elimination only at low-to-moderate antibody levels (mean fluorescence intensity [MFI], <6000). Yet, this reduction was sufficient to enable transplantation, which raises the question of whether less complex, potentially less toxic, and less costly approaches could have produced a similar decrease in the calculated . . .