IntroductionABO-incompatible kidney transplantation (ABOi-KT) expands the donor pool, yet baseline anti-ABO isoagglutinin titres ≥ 1:512 remain challenging and practice is highly variable. We surveyed the German transplant centres to capture current management of very high-titre ABOi candidates and centre responses to insufficient titre decline.MethodsThirty-six centres were invited to complete an anonymised 19-item web-based questionnaire (January–March 2025) on (i) centre activity, (ii) isoagglutinin testing and isoagglutinin titre limits (iii) desensitisation protocol, (iv) ABO abort criteria and (v) escalation & re-attempt strategies.
Data are reported descriptively.ResultsOf 36 eligible programmes, 27 (75%) responded. Thirteen (48%) accept any isoagglutinin titre; the rest cap at 1:512 (15%), 1:1024 (26%) or 1:2048 (11%).
Centres without a cap reported greater 5-year ABOi experience (median 20 vs 9 cases). IgG isoagglutinin titres are monitored in 26/27 centres, IgM in 18/27.
All centres use rituximab, usually 4 weeks pre-transplant. Antigen-specific immunoadsorption (IA) is the principal antibody-removal method in 88%, while 54% also employ plasma exchange (PLEX).
In cases of insufficient titre decline, different strategies are employed.
Frontiers in Immunology published a clinical update in Infectious Disease on 05 Jun 2026.
The item focuses on ABO-incompatible kidney transplantation with high isoagglutinin titres: practice pattern and problem solving: a German multi-centre survey.
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