Incompatible Blood Type Kidney Transplant
Transforming lives, one patient at a time
Until recently, a kidney transplant could not be performed unless both the kidney recipient and his or her donor had compatible blood types. About one-third of donors and recipients were declined due to ABO blood type incompatibility.
Now, using an innovative desensitization technique, we can eliminate a recipient's reaction to an incompatible blood type, allowing more people to receive and benefit from a kidney transplant from their friend, spouse, or family member. Our program began in June of 2008 and we transplant one person every month through this unique transplant program.
ABO blood type compatibility at a glance
O, A, B, and AB - all people have one of these four blood types. We are all compatible with our own blood type and possibly with others
AB patients--can get a kidney of any blood type. They are the universal recipient.
- A patients--can get a kidney from someone with an O or A blood type.
- B patients can get a kidney from someone with an O or B blood type.
- O patients--can only get a kidney from someone with the O blood type.
However with a blood type incompatible kidney transplant program like the one at UCLA, virtually anyone of any blood type can donate to any potential kidney transplant recipient. This means that your friend or family member, no matter what blood type they are, likely will be able to donate their kidney to you.
How do we perform ABO Incompatible Transplantation?
To prepare for ABO incompatible transplantation, a simple blood test is performed to determine the amount of antibody in the bloodstream. Most people have a level of antibody that is treatable.
The next step in the process is to schedule your kidney transplant surgery date. We usually do these transplants on Wednesdays. The operation is the same for you as it is for allother patients. You can expect to stay in the hospital for 7 days after your operation.
The final step are the treatments pre-transplant to reduce the blood group antibody. We call this two-step process desensitization and immune modulation: We remove blood group antibodies from your blood using a process plasma exchange; to many it looks similar to dialysis. However with the treatments you generally do not feel tired like you might with dialysis. Most times you will have 3 or more treatments using your dialysis access. The number of treatments depends on how much antibody you have before you receive your kidney transplant.
Then, we work to turn off the cells in your body from making more of the blood group antibodies. We use a medication called intravenous immunoglobulin or IVIg. The antibodies decline with the treatment and then the transplant can be performed. This is usually about two to three weeks after the first plasmapheresis. We
continue to monitor your antibody levels after transplant.
Two weeks after the operation, your medications and treatment regimens are the same as for blood group compatible transplant patients.
What can my kidney donor can expect?
The procedure for the person who is onating a kidney to you is exactly the same as for blood group compatible
donors. The special treatments are only necessary for you.
How do we get started?
Call (310) 794-0696
"Because of my ABO incompatible transplant, I feel like the luckiest person alive. I never thought my life would
ever be as great as it is now. I'd like to thank my wife, Dr. Lipshutz, and the transplant team for transforming
my life." - Michael S.
"The ABO incompatible transplant I received gave myself, and most importantly my family, the life back we
thought we had lost forever. If you're in need of a transplant and don't have a traditional match, it's a 'no-
brainer' option."- Keith B.
Daily Independent Sep 17, 2010
Ridgecrest, Calif. -
James and Sandra Hobby share their experiences with a new kidney transplant process.
By Ruth Justis
For James Hobby, kidney problems were a fact of life.
"I was born with hereditary polycystic kidneys. The cysts burst and put poison into your system. I always knew I'd eventually be on dialysis - my whole family was. In fact, everyone in my family died by age 47," James said.
Seven years ago, James was placed on the list for a kidney transplant. A year later, he began dialysis three days a week at a local clinic - Davita of IWV. Two years ago, he obtained a home dialysis unit, which he used five days a week.
"You lose so many hours of your life when you are dependent on a dialysis machine. It gives you a chance to live, but you are tied to it and to dietary restrictions," James said.
Transplants have always required an exact blood match to have a chance of working. There are four blood types - A, B, AB, and O. Type A can match with A or O; type B can match with B or O; AB can match with AB, A, B, or O; but type O can only match with O.
"If you receive a transplant of a different blood type, your body will recognize it as foreign and destroy it," Sandra said. "In 1989, Japanese scientists began working on A-B-O Incompatible transplants. They use a process called plasmapheresis (plas-ma-fair-ee-sis), where they take the antibodies out of your plasma and replace the plasma with a different blood type."
Plasmapheresis was introduced in the US in 2001 at Mayo Clinic and Johns Hopkins, and has been available at UCLA Medical Center for two years. Fewer than 25 percent of medical centers in the US offer the program.
After talking with doctors at UCLA for two years, Sandra decided to donate a kidney to James, even though she is blood type A and he is O. Their other option was for Sandra to donate a kidney to the donor bank and have someone else donate a type O kidney to James.
"James was transplant number 23 at UCLA, using plasmapheresis," Sandra said. "Dr. Lipshutz is a great surgeon; very cautious and thorough. He will not begin with a new patient until the previous one is over the threshold and well on his way to recovery. He even calls the patient at home to check on him."
Enlisting in the program meant that James and Sandra had to move to LA for two months. He went through daily plasmapheresis sessions before the surgery and again afterwards. He was in the hospital for 12 days.
"It's a rougher process than a regular transplant, but the result is worth it," James said. "I am through with dialysis for the rest of my life. It was an opportunity no one in my family ever had and I'm very grateful. I will have to take medication forever to make sure my body doesn't reject the kidney, but after a month, I was at the same place as any other transplant patient in that respect. The only other problem is learning to drink enough water. I've been on fluid restrictions for so many years that it's hard to reverse the habit."
"For a donor, the process is quite safe," Sandra said. "The doctor removed my kidney laparoscopically. Within three minutes, he had the kidney out and ready to go into James. They left his old kidneys in place and connected the new one to his bladder with a stent."
By the fourth day, Sandra could drive again.
"People live quite well with one kidney," she said. "More people need to be aware that they can donate a kidney and give someone else a chance at life."
Though trying the plasmapheresis process is a "leap of faith" and a more complicated procedure, the success rate is said to be 79 to 92 percent. It is not the best choice for every patient.
To learn more about plasmapheresis and other donor options, contact Suzanne McGuire, RN, Living Donor Transplant Coordinator or Dr. Gerald Lipshutz, M.D., Director of the ABO Incompatible program at (310) 794-0696. For more on becoming a donor, call (866) 672-5333.
Copyright 2010 Ridgecrest Daily Independent. Some rights reserved
Please feel free to download these publications which explain the process further and discuss our program's excellent results.
Created by C. Canadas/G.S. Lipshutz 5/3/2011