Some patients awaiting heart transplantation may develop positive panel reactive antibodies (PRA). Several reports have demonstrated that pre-transplant sensitisation is associated with decreased survival and a higher rejection rate, and leads to the development of cardiac allograft vasculopathy. We describe our experience with a highly sensitised transplant recipient. To reduce sensitisation, three courses of immunoadsorption were administered. The PRA level decreased effectively and actual cross-match was negative. The patient underwent successful heart transplantation, and desensitisation treatment continued with immunoadsorption and intravenous immunoglobulin for five courses. Graft function remains normal at 12 months post-operatively and the clinical status of the patient is stable.