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A Guide to ABO Incompatible Kidney Transplantation by Dr. Vijay Kher, Chairman, MBBS, MD, DM, DNB, Fellowship, Fellowship

Dr. Vijay Kher is one of the best nephrologists in the country with over 37 years of experience. Currently, the Chairman of Nephrology, Kidney and Urology Institute, Medanta Hospital, Gurugram, Dr. Vijay Kher specializes in Clinical Immunosuppression, Paired Exchange Donation, ABO Incompatible Transplantation, Progression of renal disease, Glomerulonephritis, and Steroid Free Immunosuppression.


After completing his MBBS from Glancy Medical College, Amritsar, he earned his MD and DM from PGIMER, Chandigarh before going for the Research Fellowship Hypertension from Henry Ford Hospital, Detroit, USA, and Clinical Fellowship Nephrology from University of Cincinnati Medical Center, USA.


Before Medanta, Dr. Vijay Kher has worked for reputed hospitals including Sher-e-Kashmir Institute of Medical Sciences, Srinagar, Indraprastha Apollo Hospitals, New Delhi, Fortis Escorts and Fortis Hospitals, New Delhi. He was instrumental in setting up nephrology departments at major hospitals in North India. He is an inspector for the DNB and DM for National Board of Education and the Medical Council of India.  


Dr. Vijay Kher is a member of several prestigious medical organizations including the American Society of Nephrology, Indian Society of Nephrology, International Society of Nephrology, Scientific and Credential Committee Past Chairman, Transplantation Society and Acute Dialysis Quality Initiative. He has to his credit over 180 research articles in national and internationally acclaimed peer-reviewed medical journals. 

Dr. Vijay Kher


ABO Incompatible Kidney Transplantation

Kidney transplant refers to the surgical procedure of replacing diseased kidneys with healthy ones from living or deceased donors. A kidney transplant is the last treatment option available to patients suffering from end-stage kidney disease. 

Living donor kidneys are a preferred choice as they:

  • Give better immunological compatibility
  • Lowers the risk of preservation-mediated graft injuries
  • Reduces the time patient stays on dialysis

Unfortunately, the rate of rejection for kidneys from living donors due to incompatible blood types and positive crossmatch is quite high.  

Kidney Transplantation

Blood Tests for Kidney Transplant

Three main blood tests are conducted to determine if the donor and recipient are a kidney match. They are

  • ABO Compatibility or Blood Typing

This test checks for antibodies to determine a match. There are 4 blood types of groups and Rh factor (+ve or -ve):

  • A+ and A- Blood Group
  • B+ and B- Blood Group
  • AB+ and AB- Blood Group
  • O+ and O- Blood Group

For kidney transplant ABO compatibility, the Rh factor is not taken into consideration.

      Donor Blood Group

 Recipient Blood Group

If the donor is Blood Type A

 A and AB


B and AB




A, B, AB, O



A and O


B and O


A, B, AB, O


*Table shows the ABO compatibility of Donor and Recipient

Tissue Typing

The next blood test is Tissue Typing which tests the HLA or the Human Leucocyte Antigen. The HLA is important to the immune system of the body. The HLA are proteins or markers that the immune system uses to determine the presence of foreign bodies.

HLA are present in the genes in Chromosome 6 and are inherited from parents. A child will inherit 50 percent from his or her mother and 50 percent from the father. Siblings with the same set of parents may share HLA markers from the range of 0 to 100 percent theoretically.

A match of 12 HLA antigens, known as zero mismatch, is desired for transplants but not always practical. A minimum of 6 markers is necessary to qualify for a kidney transplant.  A close match is essential as it promotes engraftment and reduces the risks for rejection of the transplanted kidney.

  • Serum Crossmatch

Cells from the donor are mixed with the blood serum of the recipient to check for antibodies. If the level of antibodies developed is high, the donor cells cannot survive. This test outcome is known as positive crossmatch and indicates that the donor kidney will be rejected outright. This test is conducted multiple times up until right before the transplant surgery.


How is ABO incompatibility handled for kidney transplants?

If the blood types of the donor and recipient do not match, the transplant may still proceed. The recipient has to undergo treatments to lower the antibody levels of the blood. Desensitization protocols use both therapeutic apheresis (removing harmful antibodies selectively from the blood) and immunosuppressive drugs are used as treatments for ABO incompatibility. The treatment protocols for ABO compatibility increase the chances of successful outcomes for kidney transplants.



The acute shortage of organs has prompted extensive research on ABO incompatibility. As newer treatment protocols emerge, patients can hope to reduce long wait times and reduce the risk of antibody-mediated rejection.  

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Manpreet Kaur is an Engineer by education but found her interests in research and writing. Her prolific career spans the world of health, travel and digital marketing. She is a music lover who can be found with headphones on at any time of the day. If not found in office, then it is for sure she had packed her bag and is on trip to quench her thirst for adventure.

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With over 12+ years of experience, Dr. Shruti Rastogi has expertise in managing patients suffering from various ailments. She contributes to improving public health literacy helping people make informed decisions about their well-being. Her keen eye for detail and strong medical knowledge help maintain the highest healthcare information standards.

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