early data coming from Japan demonstrated successful long-term survival ABOi KTx, in addition to subsequently coming successful results of the ABOi Ds
Tissue & blood incompatibility have commonly been considered an absolute CI to tx. This was primarily attributed to the historical poor outcome if tx was proceeded against tissue or ABO blood type barrier. However, early data coming from Japan demonstrated successful long-term survival ABOi KTx, in addition to subsequently coming successful results of the ABOi Dsz protocols in the US and elsewhere that triggered more interest in this maneuver.
o Extracorporeal removing the circulating ABO ABs, via e.g., PE or immunoadsorption
o Immunomodulating the recipient immune system, typically via
o Depleting B cell population responsible for ABO AB production, most commonly via the anti-CD20 agent .
o Ptn must show an initial ABO of . In certain centres, an initial titre of can be acceptable.
o Ptn must be willing to perform ABOi tx with all therapies related to ABOi tx.
o Concurrent HLA Dsz is NOT allowed. However, this practice is variable from centre to another, & simultaneous HLAi & ABOi tx can be performed in certain centres.
o Prior authorization regarding insurance for all therapies related to ABOi tx.
o ng/mL for the 1st month after Tx
o ng/mL for subsequent months
Following ABO Dsz and tx, ptns should be monitored with the same approach that used in TR of ABO-compatible tx. Moreover, isoagglutinin titre monitoring while ptn still in the hospital, times/wk for the 1st mo post-tx, for months 2-3 post-tx, and then -tx isoagglutinin titre , a thereafter. Ptns with a postgraft biopsy and/or pre-emptive PE should be commenced, especially with evidence of allograft dysfunction (e.g., delayed/slow graft function or increasing SCr). We do not advise routine protocol PE post-tx, irrespective to the isoagglutinin titre. We advise (unless CI) in all ABOi TR at .