ABO incompatible kidney transplantation.
OBJECTIVE
Although ABO incompatible kidney transplantation is increasingly recognized as effective, the procedure is still evolving. The purpose of this review is to summarize recent advances in this area.


RESULTS
Short to intermediate-term outcome appears good, although long-term results are still preliminary. Pretransplant risk stratification based on antidonor antibody titer may be of limited value. Splenectomy, previously reported to be an important component of ABO incompatible transplantation, appears to be avoidable under many circumstances. The wider implementation of A2 blood group incompatible transplantation shortens waiting time for deceased donor transplantation of blood group B recipients without significantly disadvantaging others. The diagnosis of acute humoral rejection has become clearer following the recognition that C4d deposition commonly occurs in well functioning ABO incompatible allografts. The long-term implications of acute humoral rejection appear substantial even following successful acute therapy, with a significant percentage of patients developing chronic humoral rejection manifested as transplant glomerulopathy. Finally, although ABO incompatible transplantation entails increased expense, when compared with maintenance dialysis and taking into account the health related quality of life benefits of a successful transplant, it is clearly cost effective.


CONCLUSIONS
ABO incompatible kidney transplantation is an effective therapy, and will become more widely implemented in the future.
Gloor
James M
JM
Department of Internal Medicine, Division of Nephrology and Hypertension and Transplant Center, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA. gloor.james@mayo.edu
Stegall
Mark D
MD
D000017:ABO Blood-Group System / Q000276:immunology*; D001787:Blood Group Incompatibility; D015935:Complement C4b; D006084:Graft Rejection / Q000191:economics / Q000517:prevention & control; D006801:Humans; D016030:Kidney Transplantation / Q000191:economics / Q000379:methods*; D010446:Peptide Fragments
D000017:ABO Blood-Group System; D010446:Peptide Fragments; D015935:Complement C4b; C032261:complement C4d