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The Human Leukocyte Antigens (HLA) are highly polymorphic molecules that can present “self” and “non-self” peptides to the immune system and thus are critical for induction of an immune response. Due to their high polymorphism and high expression rate, “non-self” or mismatched HLA are major targets for the immune system. Indeed, after blood transfusions, pregnancies or transplants, the immune system may produce antibodies against the mismatched HLA. If these circulating HLA antibodies are directed against HLA of a subsequently transplanted organ, they bind to their targets on the vascular endothelial cells of the allograft. The bound HLA antibodies will then activate the complement system as well as macrophages and neutrophils leading to severe endothelial cell damage and allograft dysfunction. This clinico-pathological entity induced by preformed donor-specific HLA antibodies is called antibody mediated or humoral rejection and is responsible for most early allograft losses. Therefore, detection of HLA-DSA prior to transplantation is an important step in the assessment of the patient’s immunological risk and for exclusion of incompatible donors.

Challenges and Clinical Significance of Virtual Crossmatch in Kidney Transplantation: Our Experience