title: ABO incompatible renal transplants: Good or bad?
abstract: ABO incompatible kidney transplantation (ABOi-KT) was previously considered to be an absolute contraindication for patients with end-stage kidney disease (ESKD) due to hyperacute rejection related to blood type barrier. Since the first successful series of ABOi-KT was reported, ABOi-KT is performed increasingly all over the world. ABOi-KT has led to an expanded donor pool and reduced the number of patients with ESKD awaiting deceased kidney transplantation (KT). Intensified immunosuppression and immunological understanding has helped to shape current desensitization protocols. Consequently, in recent years, ABOi-KT outcome is comparable to ABO compatible KT (ABOc-KT). However, many questions still remain unanswered. In ABOi-KT, there is an additional residual immunological risk that may lead to allograft damage, despite using current diverse but usually intensified immunosuppressive protocols at the expense of increasing risk of infection and possibly malignancy. Notably, in ABOi-KT, desensitization and antibody reduction therapies have increased the cost of KT. Reassuringly, there has been an evolution in ABOi-KT leading to a simplification of protocols over the last decade. This review provides an overview of the history, outcome, protocol, advantages and disadvantages in ABOi-KT, and focuses on whether ABOi-KT should be recommended as a therapeutic option of KT in the future.
authors.affiliation: Masaki Muramatsu, Magdi M Yaqoob, Carmelo Puliatti, Department of Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, United Kingdom.
authors.forename: Masaki
authors.initials: M
authors.lastname: Muramatsu
authors.affiliation: Masaki Muramatsu, Magdi M Yaqoob, Carmelo Puliatti, Department of Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, United Kingdom.
authors.forename: Hector Daniel
authors.initials: HD
authors.lastname: Gonzalez
authors.affiliation: Masaki Muramatsu, Magdi M Yaqoob, Carmelo Puliatti, Department of Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, United Kingdom.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cacciola
authors.affiliation: Masaki Muramatsu, Magdi M Yaqoob, Carmelo Puliatti, Department of Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, United Kingdom.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Aikawa
authors.affiliation: Masaki Muramatsu, Magdi M Yaqoob, Carmelo Puliatti, Department of Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, United Kingdom.
authors.forename: Magdi M
authors.initials: MM
authors.lastname: Yaqoob
authors.affiliation: Masaki Muramatsu, Magdi M Yaqoob, Carmelo Puliatti, Department of Translational Medicine and Therapeutics, William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, United Kingdom.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Puliatti
keywords: ABO incompatible; Antibody depletion; Desensitization protocols; Immunosuppression; Kidney transplantation; Living donor transplantation