Renal Transplantation Across the Abo Barrier Using A2 Kidneys

Abstract

We conclude that the allocation of blood group A2 kidneys for blood group O and B recipients is a practical way to expand the donor pool for these transplant candidates. PP may be important for reducing the levels of anti-A1 and anti-A2 antibodies and for reducing the risk of hyperacute rejection. Splenectomy seems to be unnecessary.

C4d Deposition without Rejection Correlates with Reduced Early Scarring in ABO-Incompatible Renal Allografts

“…[1][2][3][4][5][6][7] A potential risk of such procedures, however, is the continued presence or reappearance of such antibodies with resulting antibody-mediated rejection (AMR) of the graft. In conventional and HLA-incompatible renal allografts, the presence of peritubular capillary (PTC) C4d staining on an allograft biopsy, even a protocol biopsy of a stably functioning graft, is usually associated with histologic features of AMR, namely neutrophil and monocyte margination in PTC and/or thrombotic microangiopathy (TMA).…”

Outcome of an ABO-incompatible renal transplant without splenectomy

“…On the other hand, some researchers have recently reported that a splenectomy is not always necessary in A20-incompatible renal transplantations [ 3 ] . In addition, we retrospectively investigated the rate of anti-ABO titer elevation in 101 ABO-incompatible renal transplantations with splenectomy [6].…”

Characteristics, Detection, and Clinical Relevance of Alloantibodies in Kidney Transplantation

“…An expansion of the kidney donor pool can be achieved by performing transplantations despite the immunological barrier of ABOi. Successful kidney transplantation from A2 (A2B or A2O) donors to B or O recipients was reported (Alkhunaizi, 2006;Bryan et al, 1998;Nelson et al, 1998). Bryan and colleagues demonstrated that the graft outcomes in A2 donor (deceased and living) kidney recipients were comparable to ABO-compatible transplants (Bryan et al, 1998).…”

“…Indeed, for transplantation from A2 donors into B or O recipients, anti-A1 IgG titers that were above 1:128 have been shown to represent a significant risk factor for AMR (Squifflet et al, 2004;Tyden et al, 2010;Valli et al, 2009;Warren et al, 2004). In addition, Alkhunaizi reports that up to 8% of A2 individuals have anti-A1 IgG antibodies in their sera (Alkhunaizi, 2006). Anti-A1 IgG antibody titers of less than or equal to 1:8 have been considered to be a cut-off for assuming a low risk of AMR (Gloor & Stegall, 2007;Jordan et al, 2009;Rydberg et al, 2007;Warren et al, 2004).…”