Accommodation in ABO-incompatible kidney transplantation: why do kidney grafts survive?

Owing to the extreme shortage of cadaveric kidneys in Japan, ABO-incompatible kidney transplantation has been performed since 1989. We followed 441 recipients of ABO-incompatible kidney transplants. The long-term outcome did not differ significantly from that in recipients of living donor kidney transplants as a historic control group. Our data provide further evidence that humoral rejection due to ABO-antigen-antibody reaction does not occur once accommodation has been established. This report describes the characteristics of hyperacute and delayed hyperacute rejection as well as the mechanisms whereby accommodation is established in association with changes in donor (graft)-derived ABO histo-blood group glycosyltransferase, appearing in recipient blood after transplantation.