Recent advances in kidney transplantation: a viewpoint from the Descartes advisory board*

Abstract

Transplantation medicine is a rapidly evolving field. Keeping afloat of the published literature to offer the best clinical care to our patients is a daunting task. As part of its educational mission, the Descartes advisory board identified seven topics in kidney transplantation where there has been substantial progresses over the last years: kidney allocation within Eurotransplant; kidney exchange strategies; kidney machine perfusion strategies; the changing landscape of anti-human leukocyte antigen (HLA) antibodies; the new immunosuppressive drugs in the pipeline; strategies for immunosuppression minimization; and the continuous enigma of focal segmental glomerular sclerosis recurrence after transplantation. Here, we have summarized the main knowledge and the main challenges of these seven topics with the aim to provide transplant professionals at large with key bullet points to successfully understand these new concepts.

The Effect of Preservation Temperature on Liver, Kidney, and Pancreas Tissue ATP in Animal and Preclinical Human Models

“…The use and optimisation of protocols in different dynamic MP technologies for abdominal organ preservation (liver, kidney, and pancreas) have been extensively studied in the last decades in single or multi-centre randomised controlled trials (RCTs) [1] and different preclinical human and animal models. In order to expand the current donor pool and match the waitlist demand, there has been an increase in organ retrieval from different donors, such as donation after brain death (DBD), donation after circulatory death (DCD), and extended criteria donor (ECD) [2]. In particular, ECD grafts are associated with poorer transplantation outcomes and there is controversy in terms of greater overall economic costs [3].…”

Insights into the labeling effect of Kidney Donor Performance Index reporting: The Australian experience

“…In the wake of the redesign of the US Kidney Allocation System in 2014, there has been growing interest globally surrounding the role of recipient/organ longevity matching in kidney transplant allocation . After validation of a modified version of the US KDPI, Australia began reporting this score with all kidney offers despite it not being incorporated into local allocation algorithms and without changes to the clinical information available to accepting clinicians, offering an opportunity to assess for potential labeling effects associated with the reporting of this organ quality index.…”

“…the role of recipient/organ longevity matching in kidney transplant allocation. [9][10][11] After validation of a modified version of the US KDPI, 3 Australia began reporting this score with all kidney offers despite it not being incorporated into local allocation algorithms and without changes to the clinical information available to accepting clinicians, offering an opportunity to assess for potential labeling effects associated with the reporting of this organ quality index. We found that KDPI reporting has been associated with a 45% increase in the number of organ offer declines for higher-risk (KDPI > 80%) kidneys without a significant increase in the rate Our results suggest there is at a degree of labeling effect in KDPI reporting, given that the component donor information was available before the introduction of KDPI reporting.…”

Improving outcomes for donation after circulatory death kidney transplantation: Science of the times

“…DCD outcomes over time presumably involves a complex interplay of factors that includes optimized surgical procedures and immunosuppressive regimens, altered organ preservation techniques, and enhanced transport logistics [15][16][17][18][19]. Certainly, a significant impact has been the profound reduction in cold ischaemic time [16,20].…”