European Consensus on the Management of Sensitized Kidney Transplant Recipients: A Delphi Study

Lucrezia Furian*, Oriol Bestard, Klemens Budde, Emanuele Cozzi, Fritz Diekmann, Nizam Mamode, Maarten Naesens, Liset H.M. Pengel, Soren Schwartz Sorensen, Fabio Vistoli, Olivier Thaunat*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

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.

Original languageEnglish
Article number12475
JournalTransplant International
Volume37
DOIs
Publication statusPublished - 11 Apr 2024

Bibliographical note

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Copyright © 2024 Furian, Bestard, Budde, Cozzi, Diekmann, Mamode, Naesens, Pengel, Schwartz Sorensen, Vistoli and Thaunat.

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