Successful kidney transplantation with a well-matched donor despite a positive crossmatch; detection and management of sensitization secondary to an alternate allelic variant of ‘self’ HLA

Under current UK standards of deceased donor typing, the formation by the recipient of HLA antibody against an allelic variant of a ‘self’ antigen creates a particular problem for organ allocation. In the reported case, the decision to transplant was taken in the situation of a positive flow crossmatch result attributed to allelic antibody. The potential that target antigen density contributed to this patient’s subsequent good outcome is discussed.