ABO-Incompatible Donor

Human ABO blood type, which was discovered in 1901 by Tagareli and Landsteiner [1], is a major immunological barrier in organ transplantation because of a development of severe rejection due to the humoral reaction between A or B antigens and anti-A or anti-B antibodies. ABO-incompatible kidney transplantation was first performed in 1952 by Hume et al. for the patient of renal failure [2]. The transplanted kidney, however, did not function at all. Starzl et al. also performed ABO-incompatible kidney transplantation in four patients in 1964 and succeeded long-term graft survival in one patient [3, 4]. However, since a success rate was extremely low, ABO-incompatible kidney transplantation generally ceased to be performed [5]. Thereafter, in 1981, Slapak et al. reported the efficacy of plasmapheresis for the rejection after kidney transplantation with ABO incompatibility [6]. Alexandre et al. first performed ABO-incompatible kidney transplantation using the designed protocol using plasma exchange for pretransplant removal of anti-A and anti-B antibodies and splenectomy for long-term graft survival [7–9].