An important exception to ABO incompatibility is the A2 blood group: because the A2 antigen is expressed at lower levels on kidney endothelium than other antigens, A2 kidneys can be successfully transplanted into either B or O recipients without desensitization, provided the cross-match is negative and the anti-A2 titers are relatively low.
Monday, January 12, 2009
ABO Incompatibility Renal Transplant
Although the traditional dogma of kidney transplant would state that ABO incompatibility is an absolute contraindication for a kidney transplant, this is changing: there are some overall favorable reports of graft longevity in Japan, where cadaveric kidneys are in severe short supply. In order to prevent acute rejection, a desensitization protocol involving therapeutic plasma exchange, IVIG, or Rituxan (all of which would be designed to minimize circulating anti-A or anti-B antibodies in the recipient) may be employed.