ABO Incompatible Kidney Transplant- All You Need to Know

ABO Incompatible Kidney Transplant or ABOi transplantation is an allocation method in organ transplantation that allows efficient use of the available organs regardless of the ABO blood type, which would otherwise be unavailable due to hyperacute rejection. The method is mainly in use in infants and toddlers. However, research is underway to allow for increased use of this capability in adult transplants.

What is ABO I Kidney Transplant?

In the ABO I kidney transplant, the donor's blood type is not compatible with the recipient's blood type. In the past, if the recipient's blood has had any antibodies that reacted to the donor's blood type, it would definitely lead you to reject the transplant. This would, however, prevent a successful transplant. This is a new revolution in the field of transplantation because until now; the only way was to have compatible donors. However, now ABO I kidney transplant is also possible between recipients and living donors.

Rules for ABO I transplant

For undergoing the ABO I transplant, there are a few rules that all recipients must abide by. The most important one being- Anyone may receive a transplant of a type-O organ, and type-O recipients are at maximum benefit from ABO-incompatible transplants.  While the focus has been on infant heart transplants, the rules apply to other forms of organ transplantation as well.

ABO-incompatible transplantation in children

Since young children do not have a well-developed immune system, it isn't possible for them to receive organs from incompatible donors. This is known as ABO-incompatible (ABOi) transplantation. During the initial period of study, this method reduced the infant mortality rate to a great extent. Graft survival and patient mortality are usually the same between ABOi and ABOc recipients. This helps with better allocation of organs among donors but also improves graft ischemia. This reduces the time to transport organs to other patients. A child has more chances of being on the list if he/ she is in the critical stage.

Choosing the recipient

To choose whether a child is a right fit or not, a few factors are taken into consideration. Some of the important factors include-

• The recipient has not produced isohemagglutinins.
• The recipient has low levels of T cell-independent antigens.
• Exposure to nonself A and B may prolong the duration of undergoing ABOi transplantation.
• If the recipient requires an eventual retransplantation, he should be medically capable of receiving a new organ of either blood type.

Treatment

With ABO I kidney transplant, one receives medical treatment both before and after the transplant to lower antibody levels of the blood so as to reduce the risk of rejection. The treatment for antibodies include-

• Removing antibodies from the blood
• Injecting antibodies into the body so as to protect oneself from infections
• Provision of other medications that protect the new kidney from antibodies.

Future Perspectives

The latest strategy that may come in the future is reducing the blood group antigen levels in the allograft. Another approach that one follows is completely avoiding the ABO antibody barrier through kidney exchange programs. However, even after many high scale kidney exchange programs, a number of blood group O recipients piled up on the waiting list. The only option available to treat the patients in a reasonable amount of time is desensitisation.

Sharda Healthcity and ABO I Kidney Transplant

Dr Deepak Jain, the Head of Department of Nephrology, a successful kidney transplant surgeon, says that the trend has been on the rise. Being a specialist in ABO I kidney transplant, he says, "The trend where husbands are donating kidneys to save the life of their wives is on the rise." He has handled a number of cases where the patients and donors belonged to different blood groups. He says that this is the most amazing form of advancement he has seen in a while. According to him, the transplant is doing wonders for people who want to save their loved ones. With lost hopes of receiving a compatible donor, they go for ABO I transplant, which, of course, is doing wonders.