ORIGINAL RESEARCH
Transpl. Int.
Identical versus compatible blood typing: investigating best practices in lung transplantation
- HB
Helena Bugacov 1
- CC
Cristina Cusmai 1
- KL
Kenneth Li 1
- AM
Anne Michelle Montal 1
- GD
Gbalekan Dawodu 1
- TS
Tian Sun 1
- ST
Stephanie Tuminello 1
- SG
Shubham Gulati 1
- KT
Kuo-Chang Tseng 2
- JT
Joshua Taylor Bernstein 3
- DL
Daniel Laskey 1
- HS
Harish Seethamraju 1
- SS
Scott Scheinin 1
1. Icahn School of Medicine at Mount Sinai, New York, United States
2. University of California Los Angeles Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, Los Angeles, United States
3. Stevens Institute of Technology School of Business, Hoboken, United States
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Abstract
This study investigated acute rejection in ABO-compatible versus ABO-identical lung transplants from 2005–2023, with a secondary objective of comparing 5-year survival. Lung transplantation improves quality of life and survival; however, organ scarcity remains a major challenge. While ABO-identical matching has traditionally been preferred, evolving allocation policies and research have increased the use of ABO-compatible transplants to expand the donor pool. A retrospective cohort study using the UNOS database included adult recipients (n = 32,761). Comparisons were made between ABO-identical (n = 30,347) and ABO-compatible (n = 2,414) groups. Logistic regression assessed acute rejection, and Kaplan-Meier and Cox proportional hazards models evaluated 5-year survival. There was no significant difference in acute rejection (p = 0.99; OR = 1.03, 95% CI 0.86–1.21). ABO-identical transplants showed improved 5-year survival (p = 0.019; HR = 0.91, 95% CI 0.85–0.98), with benefits limited to recipients with obstructive lung disease (p = 0.043) and those in the highest LAS quartile (p = 0.014). The differential benefit of this modest association between ABO-identical matching and survival in this subpopulation remains unclear. Overall, ABO-compatible transplantation safely expands donor availability without increasing rejection risk.
Summary
Keywords
ABO blood group system, ABO blood type, Lung, Lung transplant, lung transplant - allocation
Received
10 October 2025
Accepted
04 May 2026
Copyright
© 2026 Bugacov, Cusmai, Li, Montal, Dawodu, Sun, Tuminello, Gulati, Tseng, Bernstein, Laskey, Seethamraju and Scheinin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Helena Bugacov, helena.bugacov@icahn.mssm.edu
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