{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T04:19:46Z","timestamp":1793074786043,"version":"4.5.0"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"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>Introduction<\/jats:title>\n                    <jats:p>ABO-incompatible kidney transplantation (ABOi-KT) expands the donor pool, yet baseline anti-ABO isoagglutinin titres \u2265 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Thirty-six centres were invited to complete an anonymised 19-item web-based questionnaire (January\u2013March 2025) on (i) centre activity, (ii) isoagglutinin testing and isoagglutinin titre limits (iii) desensitisation protocol, (iv) ABO abort criteria and (v) escalation &amp;amp; re-attempt strategies. Data are reported descriptively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 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. Desensitisation is halted mainly for refractory isoagglutinin titres or serious complications; 67% of programmes would re-attempt after 3\u20136 months, typically with intensified apheresis and\/or additional B-cell depletion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>German centres display marked protocol heterogeneity, but all accept very high titres, relying on rituximab plus IA. Greater experience correlates with abandonment of fixed cut-offs. Harmonised isoagglutinin titre assays, evidence-based futility criteria and multicentre registries are needed to optimise high-titre ABOi-KT.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1831754","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T13:17:10Z","timestamp":1780665430000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["ABO-incompatible kidney transplantation with high isoagglutinin titres: practice pattern and problem solving: a German multi-centre survey"],"prefix":"10.3389","volume":"17","author":[{"given":"Stefan","family":"Reuter","sequence":"first","affiliation":[{"name":"Department of Medicine D, Transplant Nephrology, University Clinics M\u00fcnster","place":["M\u00fcnster, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Jungck","sequence":"additional","affiliation":[{"name":"Medizinische Klinik I (Klinik f\u00fcr Nephrologie, Transplantationsmedizin und internistische Intensivmedizin), Kliniken der Stadt K\u00f6ln","place":["Cologne, Germany"]},{"name":"Medical Center Cologne-Merheim, University Witten\/Herdecke","place":["Cologne, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Harth","sequence":"additional","affiliation":[{"name":"Medizinische Klinik I (Klinik f\u00fcr Nephrologie, Transplantationsmedizin und internistische Intensivmedizin), Kliniken der Stadt K\u00f6ln","place":["Cologne, Germany"]},{"name":"Medical Center Cologne-Merheim, University Witten\/Herdecke","place":["Cologne, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeannine","family":"Wegner","sequence":"additional","affiliation":[{"name":"German Living Donation Register, University of M\u00fcnster","place":["M\u00fcnster, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang","family":"Arns","sequence":"additional","affiliation":[{"name":"Medizinische Klinik I (Klinik f\u00fcr Nephrologie, Transplantationsmedizin und internistische Intensivmedizin), Kliniken der Stadt K\u00f6ln","place":["Cologne, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrin","family":"Ivens","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Faculty of Medicine, University Hospital, Heinrich-Heine-University","place":["D\u00fcsseldorf, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anja","family":"M\u00fchlfeld","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Immunology, University Hospital Rheinisch-Westf\u00e4lische Technische Hochschule Aachen (RWTH) Aachen","place":["Aachen, 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