ABO blood group and related antigens, natural antibodies and transplantation

Tissue Antigens. 2006 Dec;68(6):459-66. doi: 10.1111/j.1399-0039.2006.00721.x.


The current success rate of transplant surgery and immunosuppression has led to a demand for organs that has outstripped the supply. This has required investigation of alternate strategies. Therefore, allotransplantation across the ABO blood group barrier has commenced, and pig-to-human xenotransplantation is under consideration. The first immunological barrier to both these types of transplantation is the prevention of the antibody-mediated rejection. This rejection is a result of natural preformed antibodies circulating in the serum of the recipient binding to either ABO (for allo) or alpha-galactose (alpha-Gal) (for xeno) antigens expressed on the donor tissue. These antibodies recognise antigens that are, in both cases, carbohydrate molecules with the characteristic feature that the nonreducing terminal carbohydrate is either a Gal or N-acetlygalactosamine residue in an alpha1,3 linkage. These epitopes are synthesised by closely related members of a single family of glycosyltransferases. This review discusses the carbohydrate antigens, the enzymes involved in their synthesis and the consequences of natural antibodies binding these antigens.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • ABO Blood-Group System / chemistry
  • ABO Blood-Group System / immunology*
  • Amino Acid Sequence
  • Animals
  • Antibodies / immunology*
  • Carbohydrates / immunology
  • Epitopes / immunology
  • Galactosyltransferases / analysis
  • Galactosyltransferases / chemistry
  • Graft Rejection / immunology*
  • Humans
  • Molecular Sequence Data
  • Sequence Alignment
  • Swine
  • Transplantation, Heterologous
  • Transplantation, Homologous


  • ABO Blood-Group System
  • Antibodies
  • Carbohydrates
  • Epitopes
  • Galactosyltransferases