ABO incompatibility in renal transplantation

ABO blood group incompatibility(ABO-I)was historically considered an absolute contraindication to kidney transplantation due to the significant risk of acute antibody-mediated rejection and early graft loss.Nevertheless,the urge to minimize the gap between the candidates’number on the waitlist for kidney transplants and the available kidney donors encourage investigation into finding ways to use organs from ABO-I kidney donors,especially in the era of using more potent immunosuppression therapies.This review aims to discuss a general overview of ABO-I kidney transplantation and the different protocols adopted by some transplant centers to meaningfully overcome this barrier.

Outcomes of ABO-incompatible liver transplantation in end-stage liver disease patients co-infected with hepatitis B and human immunodeficiency virus

BACKGROUND Human immunodeficiency virus(HIV)-positive patients coinfected with hepatitis B virus(HBV)are eligible for liver transplantation(LT)in Africa and Southeast Asia,particularly China.However,the outcome of HIV-HBV coinfected patients referred for ABO-incompatible LT(ABOi-LT)is unknown.AIM To clarify the outcome of ABOi-LT for HIV-HBV coinfected patients with endstage liver disease(ESLD).METHODS We report on two Chinese HIV-HBV coinfected patients with ESLD who underwent A to O brain-dead donor LT and reviewed the literature on HIV-HBV coinfected patients treated with ABO-compatible LT.The pretransplantation HIV viral load was undetectable,with no active opportunistic infections.Induction therapy consisted of two sessions of plasmapheresis and a single dose of rituximab in two split doses,followed by an intraoperative regimen of intravenous immunoglobulin,methylprednisolone,and basiliximab.Post-transplant maintenance immunosuppressive agents consisted of tacrolimus and mycophenolate mofetil,and prednisone.RESULTS At the intermediate-term follow-up,patients showed undetectable HIV viral load,CD4(+)T cell counts greater than 150 cells/μL,no HBV recurrence,and stable liver function.A liver allograft biopsy showed no evidence of acute cellular rejection.Both patients survived at 36-42 mo of follow-up.CONCLUSION This is the first report of ABOi-LT in HIV-HBV recipients with good intermediate-term outcomes,suggesting that ABOi-LT may be feasible and safe for HIV-HBV coinfected patients with ESLD.

Sixth hour transcutaneous bilirubin predicting significant hyperbilirubinemia in ABO incompatible neonates

Background:Neonates with ABO hemolytic disease are at greater risk for developing significant hyperbilirubinemia.We aimed to determine whether sixth hour transcutaneous bilirubin(TcB)could predict such a risk.Methods:TcB measurements were obtained at the 6th hour of life in blood group A or B neonates born to blood group O,rhesus factor compatible mothers.Subsequent hyperbilirubinemia was monitored and considered significant if a neonate required phototherapy/exchange transfusion.The predictive role of sixth hour TcB was estimated.Results:Of 144 ABO incompatible neonates,41(OA,24;O-B,17)had significant hyperbilirubinemia.Mean sixth hour TcB was significantly higher among neonates who developed significant hyperbilirubinemia than those who did not(5.83±1.35 mg/dL vs.3.65±0.96 mg/dL,P<0.001).Sixth hour TcB value>4 mg/dL had the highest sensitivity of 93.5%and>6 mg/dL had the highest specifi city of 99%.Area under receiver operating characteristic curve was 0.898.Conclusion:Sixth hour TcB predicts subsequent significant hyperbilirubinemia in ABO incompatible neonates.