The Virtual Crossmatch: An Essential Tool for Transplanting Sensitized Patients

Improved virtual crossmatch assessments following the implementation of solid phase HLA antibody immunoassays has significantly impacted transplantation of sensitized candidates, using either deceased or living donor organs. In deceased donor transplants, the virtual crossmatch has reduced the number of unexpected positive crossmatch tests resulting in improved organ allocation and reduced ischemia and wait times. The virtual crossmatch has also improved access to living donor transplantation by expediting donor evaluation by impacting clinical decisions regarding desensitization, and through implementation of successful kidney paired donation programs. However, continued improvements in predicting actual crossmatch outcomes are needed to further improve access to transplantation for sensitized candidates. Improved accuracy in HLA antibody strength assessments will allow for better correlations between transplant centers and the opportunity for collaborative trials to analyze transplant strategies and outcomes.