Blood Type Incompatible Program

More than one-third of willing live donors are turned down because their blood types are not compatible with the person to whom they wish to donate their kidney.

Most of us have natural antibodies against organs from people with different blood types. These antibodies can rapidly destroy a transplanted kidney.

The Blood Type Incompatible Transplant Program allows patients to receive a kidney from a live donor who has an incompatible blood type (see fig1.). Patients in this program must be willing to undergo all prescribed treatments before and after the transplant to remove harmful antibodies and decrease the risk of rejection.  

How are harmful antibodies removed?

Harmful antibodies are removed with a process called plasmapheresis, a procedure similar to dialysis that removes the plasma portion of the blood where antibodies are located. The number of plasmapheresis treatments required by the recipient before surgery varies depending on the amount of harmful antibodies in their blood.

After each plasmapheresis the recipient receives an intravenous infusion of immune globulin to replace antibodies needed to fight infections and help prevent harmful antibodies from returning. Once the antibodies against the donor’s blood type decrease to very low levels, the transplantation can take place.

Do harmful antibodies return and damage the new kidney?

To prevent the antibodies from returning and damaging the kidney, the recipient has several plasmapheresis treatments and doses of immune globulin after the transplant. In addition, the recipient’s spleen may be removed during the transplant procedure through tiny incisions. The spleen is the organ where antibodies are produced. (Please refer to the glossary for further explanation of the role of the spleen). A low level of antibodies may return after the transplant but does not appear to damage the new kidney.

How are antibodies detected?

After the transplant, the Hopkins team closely monitors the recipient for signs of rejection. This monitoring consists of regular clinic visits and twice weekly blood work to detect rising antibody levels, or decreasing kidney function. A kidney biopsy, in which small pieces of tissue are examined, also can detect rising antibody levels.

Recipients return to The Johns Hopkins Hospital several times during the first year after transplant to have kidney biopsies.

Does the recipient need extra immunosuppressive medication?

Normally, a kidney transplant recipient takes three immunosuppressive medications. A recipient who has received a blood type incompatible kidney transplant takes these same three medications, as well as five doses of a fourth medication. If rejection is suspected, the recipient may need additional plasmapheresis treatments and a kidney biopsy to determine if the rejection is due to antibodies coming back.

How successful are blood type incompatible kidney transplants?

At The Johns Hopkins Hospital, these transplants have been very successful and our results are comparable with those achieved with compatible transplants. Johns Hopkins experience shows that over 84 percent of all patients who have undergone blood type incompatible kidney transplantation at our institution continue to have a functioning kidney transplant. We believe the "Hopkins Protocol" has features that produce better results than those achieved by others in the past.

What are the requirements for transplantation?

All transplant patients undergo a standard pre-transplant evaluation at The Johns Hopkins Hospital and must be medically and surgically cleared to receive a transplant. This will involve both laboratory and X-ray testing. Some additional blood work will be necessary for patients receiving plasmapheresis. There may be some medical conditions that will need to be treated prior to the initiation of plasmapheresis. Rarely, these conditions could exclude the patient from participation in these programs. Patients who live more than three hours driving distance from The Johns Hopkins Hospital are encouraged to stay locally for a month after the transplant.

What are the requirements for potential donors?

All donors must undergo a thorough evaluation that includes laboratory testing, X-rays and urine tests for kidney function. In addition, a nephrologist (a doctor who specializes in kidney disease), a transplant surgeon, and a psychologist evaluate potential donors. The donor receives no additional therapy. They undergo the same preparation and operation as any live donor. The donor kidney is removed using a minimally invasive technique called a laparoscopic nephrectomy that was pioneered by the Johns Hopkins transplant team in 1995.