**1. Introduction**

A,B amino acid triplet level on kidney transplant survival. Transplantation 2003; 75

[102] Claas FHJ, Doxiadis IIIN. Human leukocyte antigen antibody detection and kidney allocation within Eurotransplant. Human Immunology 2009; 70 (8): 636.

[103] Gore SM, Bradley, Benjamin A. Renal transplantation : sense and sensitization. Stras‐ bourg Dordrecht; Boston: Council of Europe; Kluwer Academic Publishers, 1988. [104] Do Nguyen H, Fidler, S, Irish, A, D'Orsogna, L, Christiansen, FT, Martinez, P, Lim, W. The Idenfication of Acceptable HLA-Mismatches Improves Transplant Potential of Highly-Sensitised Renal Transplant Recipients: Sir Charles Gairdner Hospital,

[105] Amico P, Hönger G, Mayr M, Steiger J, Hopfer H, Schaub S. Clinical relevance of pre‐ transplant donor-specific HLA antibodies detected by single-antigen flow-beads.

[106] Klouda P, Corbin S, Ray T, Rogers C, Bradley B. Renal transplantation in highly sen‐ sitized pati... [Clin Transpl. 1990] - PubMed - NCBI. Clinical transplantation 1990: 69.

[107] Opelz G. Five-year results of renal transplantation in highly sensitized recipients. Collaborative Transplant Study. Transplant international : official journal of the Eu‐

[108] Tardif GN, McCalmon RT. SEOPF high-grade HLA match algorithm: effective kid‐ ney sharing using ROP trays with HLA matching for highly sensitized patients.

Royal Perth Hospital, University of Western Australia, 2012.

ropean Society for Organ Transplantation 2007; 9 (Suppl 1): S16.

Transplantation proceedings 1997; 29 (1-2): 1406.

Transplantation 2009; 87 (11): 1681.

(6): 884.

370 Current Issues and Future Direction in Kidney Transplantation

Since the discovery of the major histocompatibility complex (MHC) in 1967, there has been significant development in the field of organ and tissue transplantation. In humans, the MHC is called the human leukocyte antigen system and is located on the short arm of chromosome 6, near the complement genes. These cell surface proteins are the principal antigenic determi‐ nants of graft rejection.

The presence of donor-specific HLA antibodies in kidney transplant recipients can be identi‐ fied by crossmatch. Since 1969, pre-transplant crossmatch has become a mandatory component of the transplant work-up process. It has largely eliminated hyperacute rejection. Crossmatch techniques have expanded from basic complement-dependent microcytotoxicity (CDC) assays to additionally include flow crossmatches and virtual crossmatches derived using the luminex assay. The improved sensitivity and specificity of virtual crossmatch when compared to CDC and flow crossmatches has revolutionised the pre-transplant crossmatch process, but also greatly increased its complexity.
