I am 41 and have been on PD for the past 5 years and on the waiting list for the past 6 and suffering each day. I have a high PRA which apparently is eliminating me upfront at the crossmatch level for consideration for a transplant. I have been reading abt plasmopheresis in order to reduce antibodies, so that I may become eligible for transplant. I understand that Mayo is one of only a few centers working on desensitization protocols. My questions are 1) Is plasmapheresis the recommended 1st treatment, or is treatment with IVIG, Rituxan normally considered first? 2) I understand that a few centers are offering this treatment even if one does not have a living donor. Is this correct? 3) I understand that transplant centers are affiliated with various paired donation organizations, i.e., UNOS, Alliance for Paired Donation, etc. If I were to find a living donor who was incompatible to me, how would I increase/guarantee my chances to receive a kidney through the paired donation program if the underlying factor is that my PRA levels are so high to begin with? Would entering a chain be more beneficial? 4) I recently read that there was a paired donation that occurred between a patient in Greece and a patient in USA. This seems to be a good news in that international paired donations are happening which will widen the population of potential donors. Are other countries also participating in this program? As I have family in another country, could they be tested and possibly come to US to donate to me, or if incompatible to me, join a paired exchange program or chain?

I am sorry for being so long-winded. I am desperate for any information.
By the way, I am registered at Tulane Hospital in New Orleans.

Thank you in advance to the fine doctors at Mayo for taking time to address my questions!