ABO histo-blood group system-incompatible allografting.
Most of the 29 blood group systems known today are not restricted to erythroid tissues hence their more recent identification as histo-blood group systems. Beyond the uncontested importance of the HLA system in human allograft survival, some of the histo-blood group systems might increasingly become recognised to play a role in graft-host interaction and peritransplant transfusion therapy. At least the ABO histo-blood group system has drawn a lot of interest since both, elective ABO-mismatch with living kidney donor/recipient pairs and infant heart recipients have been described as radical, but effective treatments of end-stage organ dysfunction. More recently, at least in part successful efforts to overcome unintentional ABO-mismatched lung and heart grafts spark interest in more precisely avoiding hyperacute transplant rejection due to complement-activating anti-A/B antibodies of the recipients. Such options as to prepare the recipient with plasma exchange and following him up with polyspecific intravenous immunoglobulins, monoclonal antibodies and targeted immunosuppression using mycophenolate, rabbit antithymocyte globulin and anti-CD20 antibody rituximab are bound to efficiently remove anti-A/B antibodies and apparently inhibit their resynthesis. The present contribution overviews recently acquired knowledge on the ABO histo blood group system and the role it plays in solid organ transplantation leant against a patient observed at our institution.
Nydegger
Urs
U
Swiss Cardiovascular Center, University Clinic for Cardiovascular Surgery and University for Cardiology, Inselspital, CH-3010 Bern, Switzerland. info@immune-complex.ch
Mohacsi
Paul
P
Koestner
Simon
S
Kappeler
Andreas
A
Schaffner
Thomas
T
Carrel
Thierry
T
D000017:ABO Blood-Group System; D000818:Animals; D001787:Blood Group Incompatibility; D003167:Complement Activation; D006801:Humans; D007165:Immunosuppression Therapy; D016377:Organ Transplantation; D014184:Transplantation, Homologous
D000017:ABO Blood-Group System