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Living Donor Kidney Transplant: Blood Group Incompatibility No Longer a Constraint

By Medical Expert Team

Mar 11 , 2022 | 1 min read

Kidney transplantation is the best option for patients with End Stage Kidney Disease (ESKD). It is associated with lower mortality, the better quality of life, lower costs compared to dialysis, and patient survival of more than 95%.

Living donor transplant is the best option because it can be done before starting dialysis, once Glomerular Filtration Rate (GFR) is less than 10 ml/min or after starting dialysis but with little waiting time.

Blood group compatibility has been a limiting factor for a kidney transplant (Table 1). However, with the possibility of swap transplants and ABO-incompatible transplant, it is possible to overcome the blood group incompatibility between the donor and recipient.

Recipient	Donor
O	O
A	A, O
B	B, O
AB	AB, A, B, O

In Swap transplants (also called Paired Kidney Exchange) (especially for Blood group A/B pairs), there are two incompatible pairs (Figure 1), and kidneys are swapped so that both the recipients get blood group compatible kidney transplants.

In ABO-incompatible transplants, the recipient undergoes medication to kill B cells and decrease ABO antibody production and then plasma exchange/plasmapheresis for removal of Anti-A/B antibodies. Once this antibody titre reaches a low level, kidney transplant can be performed.

Outcomes with ABO-incompatible transplant are slightly lower than ABO compatible transplant with ~90% graft survival as there is ~10% risk of hyperacute rejection during the first 2 weeks. Following 2 weeks, even Anti-A/B antibodies deposit in the graft, it does not lead to any damage.

The combination of swap transplant and ABO-incompatible transplant has made it possible for patients with ESKD to plan transplants from their living donors without checking blood group compatibility.