ABO-incompatible renal transplantation.

From recent works, it can be concluded that renal transplantation across ABO incompatibility is acceptable if no other donor is available. Patient and graft survivals are nearly equal to those of ABO-compatible renal transplantation. Despite removal of ABO blood group antibodies before transplantation, hyperacute rejection may occur in some cases. Acute humoral rejection is the most frequent type of early rejection in an ABO-incompatible recipient, but most of these crises are controllable with the most effective antirejection therapy. Further immunopathologic studies are needed to clarify the rejection mechanism in the ABO-incompatible renal transplants. To obtain a successful outcome, immunologic preparation, including reduction of anti-A and anti-B antibody titers and splenectomy, is recommended, along with careful monitoring of antibodies, platelet counts, complement, and kidney function.