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

Area of Science:

• Nephrology
• Immunology
• Transplantation

Background:

• Sensitized patients awaiting kidney transplants face limited options and high mortality rates.
• Antibody-mediated rejection (AMR), triggered by donor-specific antibodies (DSA), is a major cause of kidney graft failure in these patients.
• The European Society for Organ Transplantation (ESOT) initiated the ENGAGE program to address care gaps for sensitized transplant candidates.

Purpose of the Study:

• To develop consensus-based recommendations for the management of sensitized kidney transplant candidates.
• To categorize patients based on AMR risk to guide treatment strategies.
• To assess current desensitization and immunomodulation protocols.

Main Methods:

• A systematic review of induction and maintenance regimens and antibody removal strategies was conducted.
• A Delphi methodology was employed, involving a Likert-scale survey distributed to 53 European experts.
• Consensus was defined as agreement among at least 75% of participants.

Main Results:

• Consensus was achieved on 95.3% of the evaluated statements regarding the care of sensitized kidney transplant recipients.
• Most recommendations were aligned among experts, indicating a general agreement on current practices.
• A lack of consensus was observed on two specific statements concerning the use of complement inhibitors for AMR prophylaxis.

Conclusions:

• The ENGAGE consensus provides contemporary, risk-stratified recommendations for desensitization and immunomodulation in sensitized kidney transplant recipients.
• Implementing tailored, patient-specific strategies is expected to optimize care and improve transplant accessibility.
• Further dedicated studies are necessary to evaluate the long-term efficacy of these proposed approaches in enhancing transplant outcomes.