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ABO Incompatible Transplantation: To B or not to B
Author(s) -
Montgomery Robert A.
Publication year - 2004
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2004.00496.x
Subject(s) - medicine , abo blood group system , transplantation , immunology
ABO antibodies (isoagglutinins) represent a formidable bar- rier to optimizing live donation and organ distribution. Blood group antigens are expressed on the endothelium of solid organs, and transplantation across a blood group barrier can result in hyperacute or acute antibody-mediated rejection (AMR). Based on blood group distributions in the United States, there is a 36% probability that any two individuals in the population will be ABO incompatible (ABOi), result- ing in the exclusion of up to one third of willing live donors. The use of ABOi kidneys dates back to the earliest days of renal transplantation. Dismal results, enhanced availability of kidneys from deceased donors, and a better organ shar- ing infrastructure pre-empted further development of ABOi transplantation in the West. However, in Japan where cul- tural beliefs have limited utilization of deceased donors, ABOi renal transplantation flourished during the 1990s. The article by Takahashi et al. (1) reports the outcomes of 441 ABOi kidney transplants performed at 55 centers across Japan and shows no significant difference in graft survival when compared with historic recipients of ABO- compatible living donor organs. This is a landmark study representing the largest series of ABOi kidney transplants with the longest follow up to date. The results are the en- dorsement that the field of transplantation has been wait- ing for and a further expansion of the practice of ABOi trans- plantation now seems inevitable. While these results are very promising, many questions remain unanswered and there is a bewildering lack of standardization of protocol and reporting (titers, rescue treatments, biopsies) among the Japanese centers.