Sistema de Salut de Catalunya
Institut Català de la Salut
[Furian L] Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine and Surgery, University of Padua, Padua, Italy. [Bestard O] Unitat de Trasplantament Renal, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Budde K] Department of Nephrology and Medical Intensive Care, Charité University Medicine Berlin, Berlin, Germany. [Cozzi E] Transplant Immunology Unit, Department of Cardiac, Thoracic and Vascular Sciences, School of Medicine and Surgery, University of Padua, Padua, Italy. [Diekmann F] Experimental Nephrology and Transplant Laboratory, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain. [Mamode N] King’s College London, London, United Kingdom
Vall d'Hebron Barcelona Hospital Campus
2024-05-03T10:29:22Z
2024-05-03T10:29:22Z
2024-04-11
Delphi; Immunomodulation; Kidney transplantation
Delfos; Immunomodulació; Trasplantament de ronyó
Delfos; Inmunomodulación; Trasplante de riñón
An increasing number of sensitized patients awaiting transplantation face limited options, leading to fatalities during dialysis and higher costs. The absence of established evidence highlights the need for collaborative consensus. Donor-specific antibodies (DSA)-triggered antibody-mediated rejection (AMR) significantly contributes to kidney graft failure, especially in sensitized patients. The European Society for Organ Transplantation (ESOT) launched the ENGAGE initiative, categorizing sensitized candidates by AMR risk to improve patient care. A systematic review assessed induction and maintenance regimens as well as antibody removal strategies, with statements subjected to the Delphi methodology. A Likert-scale survey was distributed to 53 European experts (Nephrologists, Transplant surgeons and Immunologists) with experience in kidney transplant recipient care. A rate ≥75% with the same answer was considered consensus. Consensus was achieved in 95.3% of statements. While most recommendations aligned, two statements related to complement inhibitors for AMR prophylaxis lacked consensus. The ENGAGE consensus presents contemporary recommendations for desensitization and immunomodulation strategies, grounded in predefined risk categories. The adoption of tailored, patient-specific measures is anticipated to streamline the care of sensitized recipients undergoing renal allografts. While this approach holds the promise of enhancing transplant accessibility and fostering long-term success in transplantation outcomes, its efficacy will need to be assessed through dedicated studies.
This work was supported by The European Society for Organ Transplantation (ESOT), Westerdoksdijk 423, 1013 BX Amsterdam, Netherlands, including all publication fees, with the unconditional support of CHIESI Farmaceutici S.p.A. and Hansa Biopharma. The funders were not involved in the study design, collection, analysis, interpretation of data, the writing of this article, or the decision to submit it for publication. The medical writer for this manuscript was also supported by ESOT. The authors maintained complete control over the manuscript content, and it reflects their opinions.
Article
Published version
English
Decisió de grup; Ronyons - Trasplantació; Immunoglobulines; Empelt contra l'hoste, Malaltia de l'; PSYCHIATRY AND PSYCHOLOGY::Behavior and Behavior Mechanisms::Psychology, Social::Group Processes::Consensus; PHENOMENA AND PROCESSES::Immune System Phenomena::Transplantation Immunology::Host vs Graft Reaction::Graft Rejection; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Renal Replacement Therapy::Kidney Transplantation; CHEMICALS AND DRUGS::Amino Acids, Peptides, and Proteins::Proteins::Blood Proteins::Immunoproteins::Immunoglobulins::Antibodies::Isoantibodies; PSIQUIATRÍA Y PSICOLOGÍA::conducta y mecanismos de la conducta::psicología social::procesos de grupo::consenso; FENÓMENOS Y PROCESOS::fenómenos del sistema inmunitario::inmunología del trasplante::reacción huésped contra injerto::rechazo del injerto; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::tratamiento de reemplazo renal::trasplante de riñón; COMPUESTOS QUÍMICOS Y DROGAS::aminoácidos, péptidos y proteínas::proteínas::proteínas sanguíneas::inmunoproteínas::inmunoglobulinas::anticuerpos::isoanticuerpos
Frontiers Media
Transplant international : official journal of the European Society for Organ Transplantation;37
https://doi.org/10.3389/ti.2024.12475
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
Articles científics - HVH [3440]
