Pre-emptive living kidney transplantation is the best choice of therapy to treat patients with advanced renal insufficiency. Unfortunately in up to one third of all cases kidney donation was refused due to blood group incompatibility. Limitations in donor availability for kidney transplantation therefore require that ABO-incompatible transplantation is safely established. This has changed when a new protocol was introduced in Stockholm, Sweden, in 2001. Almost 400 ABO-incompatible transplantations have since been performed in more than 20 centers with this protocol in Europe. ABO-incompatible living kidney transplantation can now be offered to our patients with advanced kidney disease as a safe procedure. To get more insight into the role ABO-incompatible organ transplantation might play in the near future transplantation centers currently involved in these processes should share their data to answer the unresolved issues we are concerned.
