{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T15:41:41Z","timestamp":1793374901326,"version":"4.5.0"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,12,2]],"date-time":"2024-12-02T00:00:00Z","timestamp":1733097600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>ABO-incompatible kidney transplantation (ABOi-KTx) represents a possible solution to address the shortage of kidney donors. However, these transplants present immunological challenges, particularly when isoagglutinin titers are elevated pretransplant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Single-center retrospective study describing clinical and biological outcomes of 8 patients who underwent ABOi-KTx with initial isoagglutinin titers \u2265 1\/512. All patients followed a desensitization protocol combining immunosuppression (rituximab, tacrolimus, mycophenolate mofetil, steroids), and specific or semi-specific apheresis sessions. Clinical and biological data were extracted from electronic medical records.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were 5 males; median age of 62 years [34-82 years]; all achieved an isoagglutinin titer of \u22641\/8 before transplantation after a median of 13 (range: 9-15) apheresis sessions. Three patients (37%) experienced acute humoral rejection, which required additional plasmapheresis sessions. Two patients developed chronic active rejection, successfully treated. On the infectious side, three patients developed BK-virus reactivation. Two patients developed cytomegalovirus viremia, and two others presented with bacterial infections. Surgically, two patients developed a lymphocele, and one had a perirenal hematoma. All patients survived the transplant with stable renal function: mean serum creatinine was 138 \u00b1 15 \u00b5mol\/L after four years of follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>ABO-incompatible kidney transplantation, even in patients with high isoagglutinin titers, is feasible and can achieve favorable long-term graft and patient survival outcomes. However, these procedures require substantial clinical expertise and close follow-up to monitor and manage the elevated risks of infection and rejection in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2024.1504495","type":"journal-article","created":{"date-parts":[[2024,12,2]],"date-time":"2024-12-02T01:24:05Z","timestamp":1733102645000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":12,"title":["Outcomes of ABO-incompatible kidney transplants with very high isoagglutinin titers: a single-center experience and literature review"],"prefix":"10.3389","volume":"15","author":[{"given":"Hamza","family":"Naciri Bennani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kadiatou Mamadou","family":"Bobo Barry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johan","family":"Noble","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Malvezzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Jouve","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lionel","family":"Rostaing","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,12,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1159\/000535583","article-title":"Outcomes of ABO-incompatible living donor kidney transplantation compared to waiting or deceased donor kidney transplantation","volume":"55","author":"Koo","year":"2024","journal-title":"Am J Nephrol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2020.03.029","article-title":"Impact of ABO-incompatible living donor kidney transplantation on patient survival","volume":"76","author":"Massie","year":"2020","journal-title":"Am J Kidney Dis"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.transproceed.2020.10.038","article-title":"ABO-incompatible living-donor kidney transplantation in a developing country: A multicenter experience in Malaysia","volume":"53","author":"Gan","year":"2021","journal-title":"Transplant Proc"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1007\/s00467-022-05583-5","article-title":"Successful ABO and HLA incompatible kidney transplantation in children in the UK","volume":"38","author":"Hew","year":"2023","journal-title":"Pediatr Nephrol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.969998","article-title":"Progression of histological lesions after ABO incompatible kidney transplantation","volume":"13","author":"Guy","year":"2022","journal-title":"Front Immunol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"19","DOI":"10.15171\/jnp.2016.04","article-title":"Early post-transplant complications following ABO-incompatible kidney transplantation","volume":"5","author":"Naciri Bennani","year":"2016","journal-title":"J Nephropathol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"290","DOI":"10.15171\/jnp.2017.48","article-title":"Long-term outcomes after ABO-incompatible kidney transplantation; 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