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ABO Incompatibility in Transplants

In the past, a transplant could not be successfully done unless the organ donor and recipient had compatible blood types. Because of this, an estimated 30% of patients needing a new kidney were turned down due to blood incompatibility issues.

Today, at the Cedars-Sinai Transplant Immunotherapy Program, innovative new procedures allow the transplant team to break the ABO incompatibility barrier. This means that people who previously had no access to a kidney transplant now can have one—with success rates nearly as high as transplant performed with blood-type-compatible recipients and donors.

Blood Type Compatibility

All people fit into one of four blood types—A, B, AB and O. Everyone is compatible with some blood types but not all of them as follows:

  • People with blood type A are compatible with donor organs (or blood) from a person with type A or O blood.
  • People with blood type B are compatible with blood type B or O.
  • People with blood type AB are compatible with blood types A, B, AB or O. They are known as universal recipients.
  • People with blood type O are compatible only with organs or blood donated by another type O person. People with type O blood are known as universal donors because all blood types are compatible with type O blood.

If a person receives a kidney from someone with an incompatible blood type, his or her body will recognize the organ as foreign and destroy it.

How ABO Incompatible Transplants Work

A process called plasmapheresis is used to overcome the ABO incompatibility between kidney donor and recipient.

Plasmapheresis removes the plasma portion of the blood. This is where the antibodies are that seek and destroy ABO incompatible organs. A person may have to undergo several sessions of plasmapheresis before surgery to bring the antibodies down. After at the last plasmapheresis treatment, the kidney recipient receives an intravenous infusion of immune globulin to replace the antibodies the body needs to fight infections and to help prevent the harmful antibodies from returning.

When the recipient's antibodies against the donor's blood type have dropped to very low levels, the transplant can take place. The kidney transplant recipient may have to undergo several more plasmapheresis and immune globulin treatments after the transplant.

Follow-Up Care After Kidney or Pancreas Transplantation

A person who has had an ABO incompatible transplant will need to be monitored carefully after the transplant surgery to make sure that rejection isn't developing. All transplant patients need to take medicines to prevent organ rejection. People who have had an ABO incompatible transplant need to take additional medicines because of the ABO incompatibility.

If there are signs of rejection, a person who has had an ABO incompatible transplant may need more plasmapheresis treatments. It may also be necessary to take a tissue sample from the new kidney to examine under a microscope to make sure that rejection is not happening.