| Summary: | HLA sensitization and ABO incompatibility continue to pose a significant barrier to expansion of living donation. In fact, either anti-blood or anti-donor HLA antibodies result in the occurrence of hyperacute rejection and graft loss. Reducing this early rejection risk by planned desensitization protocols has clearly improved the outcome of ABO-incompatible (ABOi) kidney transplantation. B-cell depletive therapy has replaced splenectomy, overcoming the disadvantages of the latter. Plasma exchange techniques have considerably reduced antibody titers, allowing better results. Thus, newer immunosuppressive protocols reduced early graft loss and early rejections episodes and, consequently, improved the long-term graft survival. Therefore, ABOi kidney transplantation can be more broadly practiced, especially to expand the pool donor and to reduce the waiting time for transplantation.
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