Sistema de Salut de Catalunya
Institut Català de la Salut
[Seron D] Servei de Nefrologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. [Rabant M] Department of Pathology, Hôpital Necker–Enfants Malades, Paris, France. [Becker JU] Institute of Pathology, University Hospital Cologne, Cologne, Germany. [Roufosse C] Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, United Kingdom. [Bellini MI] Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy. [Böhmig GA] Division of Nephrology and Dialysis, Department of Internal Medicine, Medical University of Vienna, Vienna, Austria
Vall d'Hebron Barcelona Hospital Campus
2023-01-09T18:19:02Z
2023-01-09T18:19:02Z
2022-05-20
T cell-mediated rejection; Kidney transplantation; Outcomes
Rebuig mediat per cèl·lules T; Trasplantament renal; Resultats
Rechazo mediado por células T; Trasplante renal; Resultados
The diagnosis of acute T cell-mediated rejection (aTCMR) after kidney transplantation has considerable relevance for research purposes. Its definition is primarily based on tubulointerstitial inflammation and has changed little over time; aTCMR is therefore a suitable parameter for longitudinal data comparisons. In addition, because aTCMR is managed with antirejection therapies that carry additional risks, anxieties, and costs, it is a clinically meaningful endpoint for studies. This paper reviews the history and classifications of TCMR and characterizes its potential role in clinical trials: a role that largely depends on the nature of the biopsy taken (indication vs protocol), the level of inflammation observed (e.g., borderline changes vs full TCMR), concomitant chronic lesions (chronic active TCMR), and the therapeutic intervention planned. There is ongoing variability—and ambiguity—in clinical monitoring and management of TCMR. More research, to investigate the clinical relevance of borderline changes (especially in protocol biopsies) and effective therapeutic strategies that improve graft survival rates with minimal patient morbidity, is urgently required. The present paper was developed from documentation produced by the European Society for Organ Transplantation (ESOT) as part of a Broad Scientific Advice request that ESOT submitted to the European Medicines Agency for discussion in 2020. This paper proposes to move toward refined definitions of aTCMR and borderline changes to be included as primary endpoints in clinical trials of kidney transplantation.
This initiative was supported by the European Society for Organ Transplantation.
Article
Published version
English
Ronyons - Trasplantació; Inflamació; Cèl·lules T; Rebuig (Biologia); ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Renal Replacement Therapy::Kidney Transplantation; ANATOMY::Cells::Blood Cells::Leukocytes::Leukocytes, Mononuclear::Lymphocytes::T-Lymphocytes; PHENOMENA AND PROCESSES::Immune System Phenomena::Transplantation Immunology::Host vs Graft Reaction::Graft Rejection; DISEASES::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Inflammation; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::tratamiento de reemplazo renal::trasplante de riñón; ANATOMÍA::células::células sanguíneas::leucocitos::leucocitos mononucleares::linfocitos::linfocitos T; FENÓMENOS Y PROCESOS::fenómenos del sistema inmunitario::inmunología del trasplante::reacción huésped contra injerto::rechazo del injerto; ENFERMEDADES::afecciones patológicas, signos y síntomas::procesos patológicos::inflamación
Frontiers Media
Transplant International;35
https://doi.org/10.3389/ti.2022.10135
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
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