AUTHOR=Bugacov Helena , Cusmai Cristina , Li Kenneth , Montal Anne Michelle , Dawodu Gbalekan , Sun Tian , Tuminello Stephanie , Gulati Shubham , Tseng Kuo-Chang , Bernstein Joshua Taylor , Laskey Daniel , Seethamraju Harish , Scheinin Scott 
  
TITLE=Identical versus compatible blood typing: investigating best practices in lung transplantation
  
JOURNAL=Transplant International
  
VOLUME=Volume 39 - 2026
  
YEAR=2026
  
URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2026.15722
  
DOI=10.3389/ti.2026.15722
  
ISSN=1432-2277
  
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.