History of ABO Incompatible Pancreas Transplantation

ABO-incompatible transplants are rare but have been successfully performed in liver [1–3], heart [4], kidney [5, 6], and pancreas [7] transplants. ABO-incompatible transplants are usually performed only in life-threatening emergencies or in the presence of special immunologic conditions. One such condition is a transplant from blood group A2 donors to blood group 0 recipients. Its feasibility is based on the low expression of A2 (vs Al) determinants. Favorable outcome of A2 organs transplanted into 0 recipients had already been reported in the early 1980s [8, 9]. The recipient’s IgM anti-A2 titer appeared to be a key factor: Transplants with titers <1:64 usually succeeded, whereas titers ≥1:64 tended to fail. To avoid hyperacute rejection, prospective ABO-incompatible recipients require additional treatment: elimination of ABO isoagglutinins by plasmapheresis or immunoadsorption with or without concurrent recipient splenectomy [10, 11]. Removal of antiblood group IgM isoagglutinins prevents the development of hyperacute rejection early posttransplant; the return of those isoagglutinins after several weeks posttransplant appears to have no effect on graft function.