Therapeutic Apheresis before ABO Incompatible Living Renal Transplantation

Renal transplantation is considered the gold standard therapy to treat patients with end-stage renal disease. Clinical studies showed better survival rates due to reducing comorbidities associated with dialysis treatment and a better quality of life in those patients compared to patients treated with lifelong dialysis. As a matter of fact there are too few organs available compared to patients in need of kidney transplantation. ABO incompatibility continues to pose significant barriers to further expansion of living donor kidney transplantation. Over the last two decades treatment modalities have improved to overcome these barriers and ABO-incompatible living donor kidney transplantation has been performed.The introduction of new methods to overcome the ABO barrier including plasmapheresis or immunoadsorption demonstrates that the use of ABO incompatible organs should no longer be considered contraindications for renal transplantation. In the current review we summarize the development in ABO incompatible living donor kidney transplantation utilizing innovative immunosuppressive protocols in combination with plasmapheresis or immunoadsorption. In summary, ABO incompatible living donor kidney transplantation has become a clinically safe approach to treat chronic renal failure in experienced centres promising most of the advantages of living donor kidney transplantation.