Rh antigen typing in renal transplant

Q: In Kidney transplant donors and recipients, matching for Rh antigens must be ensured as Rh antigen mismatching may lead to quick and early graft failure.

A) True

B) False

Answer: B (False)

Blood typing and crossmatching are performed per standard in all transplantations, including kidney transplants. Interestingly, though most institutions performed but matching for Rh antigens is not relevant in renal tranplant, as Rh antigens are not expressed on kidney tissue cell surfaces, Although, there may be a weak evidence that Rh antigen mismatching may cause a slight reduction in allograft survival, the overall risk is very low and Rh antigen system does not play a signficant role in allograft rejection. The highest risk exists for female Rh-negative recipients of childbearing age who are at risk for sensitization when the donor is Rh-positive.

Similarly, optimized HLA matching is very much desired; however, HLA matching between a particular donor and recipient is not required for successful transplantation. Some centers don't even perform HLA typing. The argument in favor is that with improved immunosuppressive regimens, the outcomes are acceptable (reference # 4).

In contrast, the ABO typing is required to be performed on two separate occasions before donation.

# transplantation

#kidney

References:

1. Organ Procurement and Transplantation Network: Policies. http://optn.transplant.hrsa.gov/governance/policies/ (Accessed on May 07, 2025).

2. Delmonico F, Council of the Transplantation Society. A Report of the Amsterdam Forum On the Care of the Live Kidney Donor: Data and Medical Guidelines. Transplantation 2005; 79:S53.

3. Bryan CF, Mitchell SI, Lin HM, et al. Influence of the Rh (D) blood group system on graft survival in renal transplantation. Transplantation 1998; 65:588.

4. Kim JJ, Fuggle SV, Marks SD. Does HLA matching matter in the modern era of renal transplantation? Pediatr Nephrol. 2021 Jan;36(1):31-40. doi: 10.1007/s00467-019-04393-6. Epub 2019 Dec 9. PMID: 31820146; PMCID: PMC7701071.

5. Kumbala D, Zhang R. Essential concept of transplant immunology for clinical practice. World J Transplant. 2013 Dec 24;3(4):113-8. doi: 10.5500/wjt.v3.i4.113. PMID: 24392315; PMCID: PMC3879520