Kidney transplantation in adults: ABO-incompatible Transplantation

About 30% of donor recipient pairs are predicted to be blood type incompatible. However, ABOi transplantation is a viable option for patients seeking kidney transplantation

The available options for ABO-incompatibility are

• ABOi living donor transplantation, which requires a period of desensitization of the recipient,
• Kidney paired donation where one can choose to exchange a donor to an alternate recipient with an ABO- or human leucocyte antigen-incompatible donor, and 
• Candidates with blood type B or O can receive transplantation with a kidney from a blood type non-A1 (A2) donor. 

Approach to ABOi transplantation is though patient eligibility and pretransplant ABO desensitization that is, 

• Removal of circulating ABO-antibodies
• Immuomodulation
• B cell depletion

Outcomes of ABOi transplantation is evaluated via Patient and graft survival which is associated with lower graft and patient survival within the first three years post-transplant as compared to ABO-compatible transplantation. 

However, longer term graft and patient survival rates appears to be comparable. After transplantation, prevention of infections and monitoring are crucial.

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