Kidney Transplant Matching for IgAN: Blood Type, HLA, and Donor Compatibility Explained

A kidney transplant may be a life-saving option for people with IgA nephropathy (IgAN), but finding a compatible donor involves precise matching to reduce rejection risks. Transplant teams prioritize blood type compatibility, HLA matching, and crossmatching, while newer methods like eplet matching expand possibilities. Living donor kidneys last nearly twice as long as deceased donor organs, cutting wait times and improving outcomes.

A “good match” for IgAN starts with blood type compatibility
Blood type is the first critical factor in kidney transplants, including for IgAN patients. People with blood type O, known as “universal donors,” can donate to any recipient but can only receive from type O donors. Type AB recipients, called “universal recipients,” can accept any blood type but can only donate to other AB recipients. Type A donors match A or AB recipients, while type B donors match B or AB. Some transplant centers offer treatments to bridge incompatible blood types, though these are not standard for IgAN.

“Blood type is always one of the first steps,” says Rafael Villicana, MD, medical director of kidney transplantation at Loma Linda University Health. “Like blood transfusions, kidney transplants require compatible blood types to avoid immediate rejection.”

HLA matching and crossmatching reduce rejection risks
Beyond blood type, transplant teams evaluate Human Leukocyte Antigen (HLA) markers—proteins on cell surfaces that help the immune system distinguish self from foreign tissue. The more HLA markers a donor and recipient share, the lower the risk of rejection. Close family members often share these markers, but unrelated donors can also be compatible.

A crossmatch test checks for antibodies that could attack the donor kidney. Previous transplants, blood transfusions, or pregnancy can sensitize a patient’s immune system, making it harder to find a match. “The more sensitized you are, the harder it can be to find a compatible donor,” Dr. Villicana notes.

Eplet matching offers a precision approach for IgAN
Some centers now use eplet matching, which examines smaller components of HLA markers. While HLA matching compares entire “houses,” eplet matching looks at individual features—like windows or doors—to find closer matches even among seemingly incompatible pairs. “This can trick the immune system into accepting a kidney it might otherwise reject,” says Nicole M. Ali, MD, medical director of NYU Langone’s kidney transplant program.

Research suggests that very closely matched donors may slightly increase the risk of IgAN returning in the transplanted kidney, but the focus remains on minimizing rejection risks. Eplet matching may help balance these concerns by identifying donors overlooked in traditional matching.

Living donors provide better outcomes for IgAN patients
Living donor kidneys generally function better and last longer than deceased donor organs. According to Dr. Ali, living donor kidneys last almost twice as long as typical deceased donor kidneys. This is critical for IgAN patients, who often face longer wait times for deceased donor organs. The national transplant waiting list in the U.S. exceeds 100,000 people, with most waiting for kidneys.

A living donor transplant can occur within weeks to months, sometimes before dialysis is needed—a “preemptive transplant” that reduces risks of heart disease, stroke, and rejection. “Preemptive transplants are ideal,” says Pranav Garimella, MBBS, MPH, chief medical officer at the American Kidney Fund. “They allow patients to avoid dialysis complications entirely.”

How to find a living donor for IgAN
Finding a living donor often begins with close networks. Nichole Jefferson, a two-time IgAN transplant recipient and American Kidney Fund Ambassador, emphasizes that donors can come from anywhere—family, friends, coworkers, faith communities, or even strangers moved by a patient’s story. “The journey starts with talking about your needs,” Jefferson says. “People may feel called to help if they understand what you’re going through.”

Transplant centers recommend:

• Starting conversations close to home, where family and friends can spread the word and support the search.
• Sharing your story broadly through social media, local media, or printed materials. Jefferson’s second transplant came after her story reached a stranger online.
• Using a point person to help manage outreach when energy is limited.

What if your donor isn’t a match?
Paired kidney exchanges and donor chains can still make transplants possible. In a paired exchange, two incompatible donor-recipient pairs swap kidneys if their donors are matches for each other. Donor chains start with a non-directed donor (one without a specific recipient) and extend through multiple compatible pairs. “One act of generosity can help multiple patients,” Dr. Garimella explains.

Support and resources for IgAN patients
The donor search can be emotionally taxing. Jefferson advises connecting with support groups, counselors, or patient communities like the IgA Nephropathy Foundation. “Hope is a powerful part of the journey,” she says. Staying engaged with healthcare teams and maintaining overall health also improves transplant eligibility.

For verified resources, the Cleveland Clinic, Mayo Clinic, and National Kidney Foundation provide detailed guides on IgAN and transplantation.