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ABO Incompatible Kidney Transplants
ABO Incompatible Kidney Transplant in Bangalore
Donors with incompatible blood types undergo kidney transplants.
The fact remains, that recent developments in paired donation have substantially reduced the need for the practice for the majority of individuals.
If you had antibodies in your body that reacted with that of the donor blood type in the past, the transplant would have been rejected immediately. This is because your body would reject the donor's blood type. It is imperative to note that this condition would compromise the success of a transplant. In the old days, the only way to match recipient-donor pairs with compatible ABO blood types was to identify recipients and donors with compatible ABO blood types.
There has been an advancement in medicine that has made it possible for some recipients and living donors to undergo kidney transplants even if they have an ABO incompatibility. A study has shown that some individuals were able to reduce the amount of time they remained on a waiting list by having living donors with different blood types available to them.
To reduce the level of antibodies in the blood before and after an ABO incompatible kidney transplant, medical treatment must be provided both before and after the transplant. To reduce the risk of the donor kidney being rejected by antibodies, this step is being taken.
Antigens and Antibodies Specific to Blood Groups
For kidney transplantation, the ABO antigen system refers to oligosaccharides that are predominantly found on the red blood cells as well as on the endothelial cells, tubules, and glomeruli of the kidney. In patients of different blood groups, the density of antigens on the erythrocytes varies. The percentage of Caucasian individuals with blood group A2 is 20% higher than that of Caucasian individuals with blood group A1. Organs derived from blood group A2 donors are less immunogenic due to the low expression of blood group antigen molecules (30–50%) on their erythrocytes.
With standard immunosuppressive therapy without any additional measures, ABOi kidney transplantation with A2 organs has been accomplished. As a result of bacteria in the gut, anti-A/B antibodies are formed during the early stages of infancy. In general, the majority of anti-A/B antibodies that naturally occur belong to the class of IgM antibodies. However, in some individuals with blood group O, anti-A/B antibodies are also found in the classes of IgG or IgA antibodies. It is well known that anti-A/B antibodies play a pathogenic role in solid organ transplantation. However, it is unclear just how much contribution each immunoglobulin isotype and its subclasses make to the rejection of the transplanted organ.
Aspects of Complications
Surgical complications associated with ABO transplants are similar to those associated with standard transplants, with haemorrhages being the most frequent. Haemorrhages may be caused by apheresis treatment, which may be responsible for the bleeding. In one study, there were 29% of patients who required blood transfusions, and three patients who required a second surgical operation as a result.
Haemorrhages Associated with IA Sessions
Different studies show different incidences of infectious complications. RTX, IVIG, and other immunosuppressive agents may be correlated with the intensity of desensitisation strategies (the number and type of apheresis treatments).
Graft loss in ABOi transplants is caused by ABMR. Anti-HLA antibodies and isoagglutinin levels are linked to ABMR risk.
Conclusion
The transplantation of ABOi kidneys has become a standard procedure in the past few years. With this method, about 25-30% of living donors who were previously refused will now be able to donate their kidneys. This will substantially expand the pool of living donors. Transplantation in the presence of major ABO incompatibility, nevertheless, places the patient at an increased risk of early rejection, infection, and infection-related mortality. It is therefore advisable that ABOc procedures be used whenever possible. Book an appointment at our multi-specialty hospital today.
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