Renal transplantation has benefited enormously over the last 35 years from the better identification of antibodies relevant to transplantation. This has allowed some transplants to take place in the presence of non-damaging antibodies. Attempts have been made over many years actively to overcome antibody barriers that would otherwise preclude transplantation. In the last 10 years, such measures have moved from an experimental to a clinical context. The applications of these newer techniques is, however, not straightforward and this BTS guidance sets out the special requirements of antibody incompatible transplantation.