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European Survey on Clinical Practice of Detecting and Treating T-Cell Mediated Kidney Transplant Rejection
Priyanka Koshy1,2, Lucrezia Furian3, Peter Nickerson4
1Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.
Abstract:
The KDIGO guideline for acute rejection treatment recommends use of corticosteroids and suggests using lymphocyte-depleting agents as second line treatment. Aim of the study was to determine the current practices of detection and treatment of TCMR of kidney allografts amongst European kidney transplant centres. An invitation was sent through ESOT/EKITA newsletters and through social media to transplant professionals in Europe for taking part in the survey. A total of 129 transplant professionals responded to the survey. There was equal representation of small and large sized transplant centres. The majority of centres treat borderline changes (BL) and TCMR (Grade IA-B, IIA-B) in indication biopsies and protocol biopsies with corticosteroids as first line treatment. Thymoglobulin is used mainly as second line treatment for TCMR Grade IA-B (80%) and TCMR IIA-B (85%). Treatment success is most often evaluated within one month of therapy. There were no differences observed between the large and small centres for the management of TCMR. This survey highlights the common practices and diversity in clinics for the management of TCMR in Europe. Testing new therapies for TCMR should be in comparison to the current standard of care in Europe. Better consensus on treatment success is crucial for robust study designs.
Insights
European kidney transplant centers commonly use corticosteroids for acute rejection, with lymphocyte-depleting agents like Thymoglobulin reserved for second-line treatment of antibody-mediated rejection (TCMR). Treatment success is typically assessed within one month.
Area of Science:
- Nephrology
- Transplantation Immunology
- Clinical Practice Research
Background:
- The KDIGO guideline recommends corticosteroids for acute rejection and lymphocyte-depleting agents as second-line therapy.
- Current clinical practices for detecting and treating T-cell mediated rejection (TCMR) in kidney allografts across European centers require elucidation.
Purpose of the Study:
- To investigate the contemporary diagnostic and therapeutic strategies for TCMR in European kidney transplant centers.
- To identify variations and commonalities in TCMR management among different transplant facilities.
Main Methods:
- A survey was distributed to European transplant professionals via ESOT/EKITA newsletters and social media.
- 129 transplant professionals from centers with equal representation of small and large sizes participated.
Main Results:
- Corticosteroids are the predominant first-line treatment for borderline changes and TCMR (Grade IA-B, IIA-B) in both indication and protocol biopsies.
- Thymoglobulin is primarily utilized as a second-line therapy for TCMR Grade IA-B (80%) and IIA-B (85%).
- Treatment efficacy is most frequently evaluated within one month, with no significant differences noted between small and large transplant centers.
Conclusions:
- This survey reveals widespread adherence to corticosteroids as first-line therapy and Thymoglobulin as second-line therapy for TCMR in European kidney transplantation.
- Significant diversity exists in clinical practices for TCMR management, underscoring the need for standardized treatment success metrics in future clinical trials.
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