ABO Incompatibility

In organ transplantation, ABO incompatibility has been a hurdle to successful living donor (LD) transplantation. However, over the past two decades, significant progress has been made in this field. Pretransplant desensitization, primarily with plasmapheresis and rituximab, has opened a new horizon and has led to predictable graft survival (GS) similar to ABO-compatible transplants not only in kidney but also in liver transplantation. In pancreas transplantation, ABO-incompatible living donor transplants are rarely performed. Following the encouraging results with ABO-incompatible kidney transplantation, this experience can also be applied to pancreas transplantation from LDs, particularly if a human leukocyte antigen-identical donor is available or if the potential recipient is (highly) sensitized. In this chapter, we report on the ABO-incompatible LD pancreas transplant experience in Asian countries with a focus on Japan and Korea, where deceased donor pancreas transplantation remains uncommon. Overall results with ABO-incompatible LD transplants have been favorable using effective preconditioning and immunosuppressive regimens.