Introduction:  Although short term graft survival has made tremendous improvement, long term graft survival is still lagging, and the role of non-traditional MHC molecule matching is more and more invoked. During the past decade, several studies reported on the association of MICA antibodies with worst transplantation outcomes.
Methods: We performed a retrospective review of patients’ files to evaluate the demographic, clinical characteristics and results of MICA antibody test and compare them with results of T and B cell cross match from 2013 to 2021. MICA antibodies were detected by Luminex screens. Descriptive statistical methods and Logistical regression analysis were performed to evaluate the prevalence and the association of various variables.  
Results: Out of 103 patients 58 tested positive for MICA antibodies (56%). Thirty cross match tests were done, 28 were negative. One was positive for T and B cells crossmatch, and one was positive for B cells only. Of note the majority (93%) were negative for T and B cross match test. Only 2 patients were positive T or B cells crossmatch.
Discussion: While most reports indicate the prevalence of MICA antibodies between 9 and 20%, our prevalence of 56% is among the highest. In view of the association of MICA antibodies with worst outcome, we must add our voice to the call for a review of guidelines to consider including MICA results and develop appropriate management. Plasma exchange may be considered to remove MICA antibodies prior to transplantation and ameliorate outcome.