ABO-histo blood group incompatibility in hematopoietic stem cell and solid organ transplantation
Received 13 March 2006; accepted 19 May 2006.
Abstract
In contrast to solid organ transplantation (SOT), ABO-histo blood group incompatibility is of minor importance for hematopoietic stem cell transplantation (HSCT). Patients receiving ABO-incompatible HSCT are at an increased risk for immune-mediated hematological complications including immediate and delayed hemolysis, late red blood cell engraftment and pure red cell aplasia, but seem not to have a worse overall survival or increased transplant-related mortality. This review gives an overview of the immunological mechanisms leading to complications associated with ABO-incompatible HSCT and describes approaches to prevent them. The current organ shortage in SOT stimulates the exploration of new strategies to expand the donor pool including ABO-incompatible SOT and xenotransplantation. Here, we discuss the hypothesis that ABO-incompatible transplantation may be viewed as a human in vivo model for the humoral immune mechanisms of antigen-mismatched transplantation. ABO-incompatible HSCT and SOT provide excellent possibilities to analyze graft accommodation and transplantation tolerance. Understanding the underlying mechanisms of graft survival in ABO-incompatible transplantation may facilitate new strategies to overcome the immunological barriers in SOT and xenotransplantation.
aDepartment of Internal Medicine, University Hospital Basel, Switzerland
bDepartment of Internal Medicine, Clinic for Hematology, University Hospital Zürich, Switzerland
cDepartment of Internal Medicine, Laboratory for Transplantation Immunology, University Hospital Zürich, Rämistrasse 100, C HOER 31, CH-8091 Zürich, Switzerland