How to select living donors for kidney transplantation from relatives with incompatible ABO blood types

In the March 2021 issue of “Are you suitable for kidney transplantation from an ABO-incompatible relative?” and the December issue of “Preoperative knowledge of kidney transplantation from an ABO-incompatible relative”, the editor introduced the indications and preoperative preparations for the recipient. Today, we will continue with our third lecture: Selection of living donors for kidney transplantation from ABO-incompatible relatives.
First, let’s look at the indications for living donor surgery:

1. Mental state has full autonomous behavioral capacity and can be responsible for one’s own decisions and behaviors; mental health, completely voluntary, without any additional economic conditions, is a noble behavior.
2. Age, 18-65 years old.
3. No kidney disease, such as nephritis, kidney disease, infection, stones, tumors, deformities; the large blood vessels of the kidney to be removed are normal, without deformities, sclerosis and obvious stenosis; good renal function, endogenous creatinine clearance>80 mL/min.
4. No heart, liver, or lung disease; no hypertension, diabetes, or systemic lupus erythematosus; no malignant tumors; no infectious diseases, such as AIDS, syphilis, or hepatitis; no mental illness; and no coagulation disorders [1][2].

Of course, we also need to understand the absolute contraindications for living donor surgery:

1. Widely metastatic or uncured tumors;
2. Severe mental illness and difficult-to-solve psychological and social problems;
3. Irreversible organ failure;
4. Severe neurological damage such as irreversible brain damage;
5. Drug abusers;
6. Acute active hepatitis;
7. Endogenous creatinine clearance <70 mL/min;
8. Body mass index (BMI) >35 kg/m2;
9. Age <18 years [2][3].

In addition, there are some relative contraindications that need to be noted:

1. Tumors that have been cured;
2. Chronic liver disease, such as chronic hepatitis B or chronic hepatitis C;
3. HIV infection;
4. History of drug abuse;
5. Severe urinary tract malformations, neurogenic bladder, etc.;
6. Severe malnutrition or cachexia;
7. Evidence of poor compliance;
8. Lack of family and social support;
9. Active infection;
10. Abdominal aorta and inferior vena cava disease;
11. Endogenous creatinine clearance 70-80mL/min;
12. BMI>30 kg/m2;
13. Suffering from other diseases, such as diabetes, hypertension, hyperthyroidism, and urinary tract stones [2].

Finally, it is worth mentioning that in some cases, hepatitis B virus (HBV) and hepatitis C virus (HCV) positive donors may also be able to donate kidneys to HBV and HCV positive recipients, respectively.

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