From the Guidelines
In ABO-incompatible (ABOI) kidney transplant recipients, the blood group to transfuse post-operatively should match the recipient's original blood type, not the donor's blood type. This approach is based on the principle that antibodies to major blood group antigens can cause hyperacute rejection and graft failure, as outlined in the clinical practice guidelines for the evaluation of renal transplantation candidates 1. The current practice is to ensure that the blood group of the recipient is compatible with that of the donor, and efforts to transplant kidneys from donors whose blood group is incompatible with the recipient should be considered experimental 1.
Key considerations in transfusing blood products to ABOI kidney transplant recipients include:
- Preventing potential hemolytic reactions that could occur if donor-type blood were given, as the recipient continues to produce antibodies against the donor's blood type
- Ensuring that all blood products are leukocyte-reduced to minimize the risk of allosensitization
- Using O-negative packed red blood cells as a universal donor option in emergency situations where type-specific blood is unavailable, though this should be avoided when possible to prevent unnecessary antibody responses
- Regular monitoring of antibody titers against the donor blood type throughout the post-transplant period
For example, if a type B recipient received a kidney from a type A donor, they should still receive type B blood products post-operatively. This approach prioritizes the safety of the recipient and minimizes the risk of complications, in line with the recommendations for ABOI kidney transplantation 1.
From the Research
Blood Group Transfusion in ABO-Incompatible Kidney Transplant
- The blood group to transfuse post-operative in an ABO-incompatible kidney transplant is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, the studies discuss the desensitization protocols and immunosuppressive regimens used in ABO-incompatible kidney transplantation, which may imply that the blood group to transfuse would be compatible with the recipient's blood group to avoid further immunological complications 2, 3, 4, 5, 6.
- The desensitization protocols mentioned in the studies involve the removal of anti-A or anti-B antibodies using plasmapheresis or immunoadsorption, and the use of immunosuppressive agents such as rituximab, tacrolimus, mycophenolate mofetil, and steroids 2, 3, 4, 5, 6.
- The goal of these protocols is to reduce the risk of antibody-mediated acute rejection and ensure the long-term survival of the graft 2, 3, 4, 5, 6.
Desensitization Protocols and Blood Transfusion
- The studies suggest that the desensitization protocols used in ABO-incompatible kidney transplantation are effective in reducing the risk of acute rejection and ensuring the long-term survival of the graft 2, 3, 4, 5, 6.
- However, the studies do not provide specific guidance on the blood group to transfuse post-operative in an ABO-incompatible kidney transplant 2, 3, 4, 5, 6.
- It is likely that the decision on the blood group to transfuse would be made on a case-by-case basis, taking into account the individual patient's immunological status and the specific desensitization protocol used 2, 3, 4, 5, 6.