For the past twenty years, it has been largely accepted that renal transplantation is the gold standard modality of renal replacement therapy (RRT) for patients with end-stage renal disease (ESRD). Subsequent to this evidence of improved survival with kidney transplantation, there have been significant improvements with respect to laparoscopic living donor nephrectomy techniques, leading to compatible living donor kidney transplantation becoming the ideal transplant outcome for patients wait-listed for transplantation. Unfortunately, for many patients this treatment modality may not be achievable, either due to a lack of compatible living donor, or as a consequence of developing either anti-ABO antibody or, as a result of prior sensitisation, anti-HLA antibody. The goal of this thesis is to examine the possibilities of expanding the limits of transplantation for such patients.