From the Research
A titre of 1:32 can be considered safe to proceed with an ABO-incompatible (ABOI) kidney transplant, provided that the patient undergoes desensitization and immunosuppression protocols, and close monitoring is performed post-transplant. The decision to proceed with transplantation at this titre level depends on the specific transplant center's protocols and the individual patient's circumstances. Most centers aim for a target titre of 1:8 or 1:16 pre-transplant, but some accept 1:32 as acceptable, as seen in studies such as 1 which discusses current protocols and outcomes of ABO-incompatible kidney transplantation.
Prior to transplantation, patients typically undergo desensitization with plasmapheresis or immunoadsorption to reduce antibody levels, combined with rituximab to suppress antibody production, as described in 2 and 3. Additional immunosuppression often includes tacrolimus, mycophenolate mofetil, and corticosteroids. The choice of desensitization method and immunosuppressive regimen can impact the safety and efficacy of the transplant, as highlighted in 4 which discusses the use of pretransplantation immunosuppression with tacrolimus, mycophenolate mofetil, and steroid.
Post-transplant, antibody titres should be monitored closely, especially in the first two weeks, as a rising titre may indicate antibody-mediated rejection requiring prompt treatment, as noted in 5 which evaluates different methods for antibody titre determination in ABO-incompatible kidney transplantation. The rationale for titre reduction is that lower levels of anti-blood group antibodies reduce the risk of hyperacute and acute antibody-mediated rejection against the donor kidney. Even with a titre of 1:32, close monitoring and readiness to treat any signs of rejection are essential for transplant success.
Key considerations in the management of ABO-incompatible kidney transplantation include:
- Desensitization protocols to reduce antibody levels
- Immunoadsorption or plasmapheresis to remove anti-ABO antibodies
- Use of rituximab to suppress antibody production
- Close monitoring of antibody titres post-transplant
- Readiness to treat any signs of rejection promptly
- Individualization of care based on the patient's specific circumstances and the transplant center's protocols, as discussed in 1 and 3.