|
| (1) Pretransplant identification of high-risk patients |
| Donor-independent |
(i) CDC-PRA-DTT ≥85% (current or historical)
(ii) HLA class I and II antibody positivity in ELISA
(iii) HLA class I positivity in ELISA (retransplant) |
| Donor-dependent |
(i) Positive CDC B-cell crossmatch in retransplant recipients with HLA class II antibody positivity in ELISA
(ii) Positive CDC T-cell crossmatch
(iii) DSA ≥1,000 MFI (living donor; since April 2009)
(iv) DSA ≥1,000 MFI and sCD30 ≥ 80 ng/ml (since October 2016) |
|
| (2) Good HLA match in patients with HLA class I and class II antibody positivity in ELISA (deceased donor) |
(i) CDC-PRA-DTT ≥10%: 0-1 HLA-A, -B, -DR mismatches
(ii) CDC-PRA-DTT <10%: 0-2 HLA-A, -B, -DR mismatches |
|
| (3) Acceptable Mismatch Program of Eurotransplant (deceased donor) |
| (i) CDC-PRA-DTT ≥85% (current or historical) |
|
| (4) Pretransplant treatment |
(i) Single plasmapheresis (deceased donor)
(ii) Repeated immunoadsorption (living donor)
(iii) Triple immunosuppression (tacrolimus + enteric-coated mycophenolic sodium + methylprednisolone; in the case of living donor, together with the initiation of apheresis therapy)
(iv) Rituximab 375 mg/m2 (when all crossmatches are negative)
(v) Thymoglobulin 1.5 mg/kg body weight preoperatively and a median of 2 times (range: 1–6) postoperatively (since April 2009; IL-2 receptor antagonist basiliximab before April 2009) |
|
| (5) Posttransplant treatment |
(i) Repeated plasmapheresis (deceased donor)
(ii) Repeated immunoadsorption (living donor) |
|
| (6) Protocol biopsies |
| (i) On days 7 and 90 (since November 2007) |
|
| (7) Posttransplant monitoring of DSA |
(i) On days 0, 7, 30, 180, and every 6 months thereafter
(ii) If deterioration of allograft function
(iii) C1q assay if DSA ≥3,000 MFI (since March 2016) |
|
