How an ABO-incomcatible graft may survive by phenotype-specific glycosylation of the host. A hypothesis.

In contrast to non-nucleated ABO-incompatible red cells, which from a HLA-compatible donor are transfused to a blood group O(H) recipient and undergo immediate destruction, a nucleated, metabolic active tissue that from the same donor is transplanted to the same recipient may show extremely long survival times. In fact, expanding the concept of “glycosidic exclusion”, a transplanted ABO-incompatible, metabolically active tissue may use its phenotype-specific enzymatic equipment to contribute to a compatible environment by consistent glycosylation of complementary sites of the plasma proteins and the B-cell surfaces of a HLA-compatible recipient.