4. Antibody-Incompatible Transplantation

  1. Nizam Mamode1 and
  2. Raja Kandaswamy2
  1. Nizam Mamode

Published Online: 23 DEC 2012

DOI: 10.1002/9781118483664.ch4

Abdominal Organ Transplantation: State of the Art

Abdominal Organ Transplantation: State of the Art

How to Cite

Mamode, N. (2013) Antibody-Incompatible Transplantation, in Abdominal Organ Transplantation: State of the Art (eds N. Mamode and R. Kandaswamy), John Wiley & Sons, Ltd, Chichester, UK. doi: 10.1002/9781118483664.ch4

Editor Information

  1. 1

    Guy's and St Thomas' Hospital, Great Ormond Street Hospital, London, UK

  2. 2

    Department of Surgery, University of Minnesota, Minneapolis, MN, USA

Author Information

  1. Guy's and St Thomas' Hospital, Great Ormond Street Hospital, London, UK

Publication History

  1. Published Online: 23 DEC 2012
  2. Published Print: 12 FEB 2013

ISBN Information

Print ISBN: 9781444334326

Online ISBN: 9781118483664

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Keywords:

  • Blood group incompatible;
  • highly sensitised;
  • antibody removal

Summary

Antibody incompatibility has been a central issue in renal transplantation from the beginning; over 50 years ago, Hume and colleagues at the Brigham Hospital described early attempts to transplant kidneys into the thigh. In reporting their experience, they described the transplantation of a kidney from a blood-group-B donor into a 28-year-old, blood-group-O female recipient. After initial function, urine output decreased, and the organ was removed after 7 days. Histology showed infarction of the kidney. This would appear to be the first recorded case of blood-group-incompatible transplantation, and it suggests the development of hyperacute rejection. Subsequently, seminal work in the 1960s by Terasaki and colleagues determined the importance of human leukocyte antigen (HLA) antibodies in transplantation and the need for a negative crossmatch prior to implantation. With the recognition that allografts were doomed to fail in the presence of significant circulating antibody in the recipient against donor antigens, antibody-incompatible transplantation (AIT) was rarely performed until the 1980s, when several groups began to attempt antibody removal in order to avoid hyperacute rejection. By the last decade of the 20th century, a mismatch between organ supply and demand generated more interest in AIT; results improved and larger series were reported, so that currently many large-volume transplant centers have an antibody-incompatible program.