Blood group incompatibility in kidney transplantation: definitely time to re-examine!

We report a successful kidney transplant (A1 donor to an O recipient), with antibody removal pre- and post-transplant, and pre-transplant administration of anti-CD20 monoclonal antibody (rituximab), intravenous immunoglobulin, and conventional transplant immunosuppression. The transplant, which was performed without splenectomy, is the first such transplant in Australia. At 20 months, the patient's creatinine level was 110-130 micromol/L, with no evidence of rejection and no complications. ABO-incompatible transplantation should increase "live donor" kidney transplantation, reduce waiting times, and improve patient outcomes.