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Positive Virtual Crossmatch — ESENeph MCQ

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HardTransplantationPositive Virtual CrossmatchESENeph

A 60-year-old man with ESKD on haemodialysis has a functioning kidney transplant offer but his latest PRA is 98% and he has multiple HLA antibodies. The offered kidney has an HLA mismatch against which he has DSA. A virtual crossmatch is positive. Can this transplant proceed?

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Correct answer: C — No – a positive virtual crossmatch indicates unacceptable immunological risk without desensitisation

A positive virtual crossmatch (presence of DSA against donor HLA antigens at significant strength) predicts a very high risk of hyperacute or accelerated antibody-mediated rejection. The transplant should not proceed without desensitisation (if feasible). Options include declining this organ and waiting for a better match, or embarking on a desensitisation protocol (plasma exchange, IVIg, Rituximab) if the clinical situation warrants. NHSBT allocation prioritises highly sensitised patients for better-matched offers.

Reference: BTS 2018 – Antibody-Incompatible Transplantation; NHSBT Allocation Policy