[Renal transplantation from ABO incompatible donors]

Abstract

ABC-incompatible (ABOi) living donor renal transplantation is being developed since the 80s, and may provide a significant source of organs. Blood group A and B antigens are expressed not only on red blood cells but also on renal vascular endothelial and renal epithelial membranes. Each individual has preformed natural antibodies against his/ her absent A and/or B antigens. These antibodies may directly damage the ABOi allograft and cause its diffuse thrombosis and primary non-function. ABOi allogratf recipients are conditioned with one dose of rituximab (as a "pharmacological splenectomy") and oral immunosuppressive treatment is introduced several days pre-operatively. Anti A/B titers are lowered by plasmapheresis or specific immunoadsorption. Close follow-up is mandatory in the first two weeks after transplantation, due to higher acute humoral rejection risk, until reaching an "accommodation" state. Thereafter, graft and patient survivals are the same as those of ABO compatible renal transplantations.