Both atrovastatin and mycophenolate mofetil (MMF) have been used for PRA reduction in transplant candidates. The purpose of this current investigation was to perform a pilot study to compare the effect of MMF and atrovastatin on panel reactive antibody in sensitized hemodialysis patients waiting for renal transplantation. A total of 40 adult patients with ESRD who were highly sensitized to HLA antigens (PRA>40%) enrolled. Patients were randomly assigned in Atorvastatin or MMF group. 20 patients received Atorvastatin and 20 patients received MMF for two months. PRA status determinations were performed at monthly intervals at the end of first and second month. The complete response to the therapy defined as decrease in PRA by 50% or more compared to baseline values at the end of trial was determined in both groups. Results Baseline PRA levels were similar in both groups. PRA changes in MMF group were not significant. 40% of patients in Atorvastatin group compared with 5% of patients in MMF group showed the complete response (p=0.02). PRA reduction in atorvastatin group was significantly higher than MMF group (p=0.01). No major infectious or other complications occurred in our patients. Two months treatment with atorvastatin reduces PRA in highly sensitized hemodialysis patients. MMF was not effective on PRA in our study. We conclude that Atorvastatin is effective and safe in reducing PRA levels in highly sensitized patients with ESRD. There is no role for MMF in this situation.