ABO blood group incompatibility: a diminishing barrier to successful kidney transplantation?
Blood type-incompatible transplantation has gained wide acceptance over the last decade. This is largely the result of B-cell-directed therapies aimed at modulating anti-blood group antibodies, which were the cause of the poor outcomes originally seen. Now rituximab (anti-CD20 and anti-B cell) has largely replaced splenectomy in preconditioning protocols, allowing for the wider implementation of ABO-incompatible transplants. Plasma exchange followed by intravenous immunoglobulin is also critical for the success of ABO-incompatible transplants. In this article, we describe the important contributions immunomodulatory drugs and antibody reduction therapies have made in achieving excellent outcomes in what was once an impenetrable barrier to transplantation.
Kahwaji
Joseph
J
Comprehensive Transplant Center, Transplant Immunotherapy Program, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA. kahwajij@cshs.org
Vo
Ashley A
AA
Jordan
Stanley C
SC
D000017:ABO Blood-Group System / Q000276:immunology; D000818:Animals; D000906:Antibodies / Q000276:immunology; D058846:Antibodies, Monoclonal, Murine-Derived / Q000494:pharmacology / Q000627:therapeutic use*; D006084:Graft Rejection / Q000097:blood / Q000517:prevention & control*; D006648:Histocompatibility; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D056747:Immunomodulation; D016030:Kidney Transplantation; D010951:Plasma Exchange; D000069283:Rituximab; D019172:Transplantation Conditioning / Q000379:methods
D000017:ABO Blood-Group System; D000906:Antibodies; D058846:Antibodies, Monoclonal, Murine-Derived; D016756:Immunoglobulins, Intravenous; D000069283:Rituximab