Due to the shortage of deceased donor the search for suitable kidney from living donors has intensified. Unfortunately, recipient-donor couples are often HLA-mismatched due to the high polymorphism of HLA loci. Nowadays patients often need more than one transplant during their lifetime and are at major risk factor for developing anti-HLA antibodies. To deal with this problem, we increased the number of tests and their sensitivity, and by carrying out accurate HLA-typing to ensure more appropriate organ allocation and the efficient follow-up and treatment of recipients. We increased our catalogue of assays and developed guidelines for physicians regarding the acceptance of organs and an adequate follow-up of their patients. With strategies such as living-donor, ABO-incompatible kidney transplantation and compatible non-directed donor exchange, we have so far obtained 100% graft survival for all types of living-donor kidney transplantation, as well as an excellent survival rate for pancreas and islet grafts.