Virtual crossmatching has the ability to predict the outcome of the final crossmatch based on HLA antibody screening and identification. Recent technological advances in HLA antibody identification using the solid-phase multiplexing platform (Luminex 100/200) have overcome many of the sensitivity and specificity issues, allowing for more accurate anti-HLA antibody identification. Prediction of the final crossmatch in the past has been difficult because of less specific and sensitive crossmatch techniques, i.e., complement-dependent cytotoxic (CDC) and flow cytometric crossmatch. In this chapter, we cover all the aspects of virtual crossmatch, its pros and cons, how to interpret the VC result, and predict transplant risk assessment. We should also understand the background of the VC result, compare it with other crossmatch assays, panel reactive antibody (PRA) status, single antigen bead (SAB) assay, and clinical history of sensitization. We are presenting two clinical cases which show how the pre-transplantation risk assessment by (SAB) analysis of the presence of DSA (donor-specific antibody) against the donor with semi-quantitative MFI value evaluation. Virtual crossmatch can help in the selection of a suitable donor. If virtual crossmatch shows positivity against the donor, then one can switch to Kidney Pair Donation (KPD) option for HLA and ABO sensitized recipients.