Advancement in preoperative desensitization therapy for ABO incompatible kidney transplantation recipients

• Published in: Transplant immunology Vol. 80; p. 101899
• Main Authors: Ma, Yuhua, Man, Jiangwei, Gui, Huiming, Niu, Jiping, Yang, Li
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.10.2023
• Subjects: ABO Blood-Group System; ABO incompatible kidney transplantation; Antibodies; Antibody; Basiliximab; Blood Group Incompatibility; Desensitization; Graft Rejection - prevention & control; Graft Survival; Humans; Immunosuppression Therapy - methods; Kidney Transplantation; Living Donors; Rituximab; ESRD; SePE; ABOi-KT; FFP; RRT; USRDS; IA; CKD; DFPP; mPD; Desensitization; Antibody; AMR; MMF; Rituximab; IVIG; KT; CP; NA; ATG; PD; PE; Basiliximab; ABO incompatible kidney transplantation; TAC; HAR; ABOc-KT; HD
• ISSN: 0966-3274; 1878-5492
• DOI: 10.1016/j.trim.2023.101899

ABO incompatibility has long been considered an absolute contraindication for kidney transplantation. However, with the increasing number of patients with ESRD in recent years, ABO-incompatible kidney transplantation (ABOi-KT) has expanded the types of donors by crossing the blood group barrier through preoperative desensitization therapy. At present, the desensitization protocols consist of removal of preexisting ABO blood group antibody titers and prevention of ABO blood group antibody return. Studies have suggested similar patient and graft survival among ABOi-KT and ABOc-KT recipients. In this review, we will summarize the effective desensitization regimens of ABOi-KT, aiming to explore effective ways to improve the success rate and the long-term survival rate of ABOi-KT recipients. •ABOi-KT has expanded the types of donors by crossing the blood group barrier through preoperative desensitization therapy.•High antibody titers can lead to antibody-mediated rejection (AMR) and prevent renal transplantation across ABO barriers.•The desensitization protocols consist of removal of preexisting ABO blood group antibody titers and prevention of return.•Accommodation, a condition that no rejection occurs even in the presence of an antibody against donor organs.