Aim At the forefront of Australia’s kidney allocation protocols is the National Interstate change (NIE) designed primarily to facilitate allocation to recipients that are very well HLA matched with the donor. Currently 976 patients (25% cPRA > 90%) are wait listed for a kidney. NIE still relies heavily on a pre-transplant CDCXM as the final determinant prior to the offer of the organ, shipment of the kidney to the interstate transplant units. To facilitate this system, a process of shipping recipient sera to five state HLA labs occurs each month. This is costly and labour intensive. Methods Australia’s population distribution, geographical isolation, HLA diversity were factors considered in the development of the NIE program over 30 years, however with the increase demands on lab resources, after hours services, organ donors and greater complexity of recipient HLA Ab profile, the current system needs to change. Recipient work up involves defining unacceptable antigens on the basis antibodies with >8000 MFI annual SAB test. In March 2016, the allocation system was changed to include cPRA in the matching algorithm. This change has resulted in an increase of highly sensitised patients being transplanted compared to previous years. Results From 1 st March 2016 to 1 st March 2017, 814 kidneys were donated 56 allocated and transplanted via NIE with 658 transplanted locally. Over 650 recipients were XMed, with only 13 CDC positive XMs which resulted in offers not progressed or declined. These positive CDCXMs were the result of IgG or IgM HLA Abs not detected during the routine screening. Conclusions Although the incidence of positive CDC XM is low, transition to a VXM, we will need to improve patient antibody profiling. Increasing the frequency of recipient screening will improve the definition of unacceptable donor antigens. Assessment of the titre of the HLA antibody not based purely on MFI, is also required in order to have a better understanding of the recipients true level of sensitisation. This is required, in order to gain clinical confidence in accepting a kidney offer without a prospective CDCXM between recipient and donor. Re-evaluation of the current system is required however gaining national acceptance of the change maybe an even larger challenge.