TY - JOUR
T1 - European Consensus on the Management of Sensitized Kidney Transplant Recipients
T2 - A Delphi Study
AU - Furian, Lucrezia
AU - Bestard, Oriol
AU - Budde, Klemens
AU - Cozzi, Emanuele
AU - Diekmann, Fritz
AU - Mamode, Nizam
AU - Naesens, Maarten
AU - Pengel, Liset H.M.
AU - Schwartz Sorensen, Soren
AU - Vistoli, Fabio
AU - Thaunat, Olivier
N1 - Publisher Copyright:
Copyright © 2024 Furian, Bestard, Budde, Cozzi, Diekmann, Mamode, Naesens, Pengel, Schwartz Sorensen, Vistoli and Thaunat.
PY - 2024/4/11
Y1 - 2024/4/11
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85191179053&partnerID=8YFLogxK
U2 - 10.3389/ti.2024.12475
DO - 10.3389/ti.2024.12475
M3 - Article
C2 - 38665475
AN - SCOPUS:85191179053
SN - 0934-0874
VL - 37
JO - Transplant International
JF - Transplant International
M1 - 12475
ER -