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

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          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.

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          Machine perfusion or cold storage in deceased-donor kidney transplantation.

          Cyril Moers, Jacqueline Smits, Mark-Hugo J Maathuis … (2009)
          Static cold storage is generally used to preserve kidney allografts from deceased donors. Hypothermic machine perfusion may improve outcomes after transplantation, but few sufficiently powered prospective studies have addressed this possibility. In this international randomized, controlled trial, we randomly assigned one kidney from 336 consecutive deceased donors to machine perfusion and the other to cold storage. All 672 recipients were followed for 1 year. The primary end point was delayed graft function (requiring dialysis in the first week after transplantation). Secondary end points were the duration of delayed graft function, delayed graft function defined by the rate of the decrease in the serum creatinine level, primary nonfunction, the serum creatinine level and clearance, acute rejection, toxicity of the calcineurin inhibitor, the length of hospital stay, and allograft and patient survival. Machine perfusion significantly reduced the risk of delayed graft function. Delayed graft function developed in 70 patients in the machine-perfusion group versus 89 in the cold-storage group (adjusted odds ratio, 0.57; P=0.01). Machine perfusion also significantly improved the rate of the decrease in the serum creatinine level and reduced the duration of delayed graft function. Machine perfusion was associated with lower serum creatinine levels during the first 2 weeks after transplantation and a reduced risk of graft failure (hazard ratio, 0.52; P=0.03). One-year allograft survival was superior in the machine-perfusion group (94% vs. 90%, P=0.04). No significant differences were observed for the other secondary end points. No serious adverse events were directly attributable to machine perfusion. Hypothermic machine perfusion was associated with a reduced risk of delayed graft function and improved graft survival in the first year after transplantation. (Current Controlled Trials number, ISRCTN83876362.) 2009 Massachusetts Medical Society
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            Belatacept and Long-Term Outcomes in Kidney Transplantation

            Flavio Vincenti, Lionel Rostaing, Joseph Grinyo … (2016)
            In previous analyses of BENEFIT, a phase 3 study, belatacept-based immunosuppression, as compared with cyclosporine-based immunosuppression, was associated with similar patient and graft survival and significantly improved renal function in kidney-transplant recipients. Here we present the final results from this study.
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              Renal transplantation after ex vivo normothermic perfusion: the first clinical study.

              M L Nicholson, S A Hosgood (2013)
              Ex vivo normothermic perfusion (EVNP) is a novel method of preservation that restores circulation and allows an organ to regain function prior to transplantation. The aim of this study was to assess the effects of EVNP in kidneys from marginal donors. Eighteen kidneys from extended criteria donors (ECD) underwent a period of EVNP immediately before transplantation. Kidneys were perfused with a plasma free red-cell based solution at a mean temperature of 34.6°C. The outcome of these kidneys was compared to a control group of 47 ECD kidneys that underwent static cold storage (CS). The mean donor age was 61 ± 1 years in the EVNP and 62 ± 6 years in the CS group (p = 0.520). EVNP kidneys were perfused for an average of 63 ± 16 min and all were transplanted successfully. The delayed graft function rate (DGF), defined as the requirement for dialysis within the first 7 days was 1/18 patients (5.6%) in the EVNP group versus 17/47 (36.2%) in the CS group (p = 0.014). There was no difference in graft or patient survival at 12 months (p = 0.510, 1.000). This first series of EVNP in renal transplantation demonstrates that this technique is both feasible and safe. Our preliminary data suggests that EVNP offers promise as a new technique of kidney preservation.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Nephrol Dial Transplant
                Journal ID (iso-abbrev): Nephrol. Dial. Transplant
                Journal ID (publisher-id): ndt
                Title: Nephrology Dialysis Transplantation
                Publisher: Oxford University Press
                ISSN (Print): 0931-0509
                ISSN (Electronic): 1460-2385
                Publication date (Print): October 2018
                Publication date (Electronic): 12 January 2018
                Publication date PMC-release: 12 January 2018
                Volume: 33
                Issue: 10
                Pages: 1699-1707
                Affiliations
                [1 ]Department of Nephrology, Universitair Ziekenhuis Antwerpen, Edegem, Belgium
                [2 ]Department of Nephrology, Medical University of Vienna, Vienna, Austria
                [3 ]Department of Nephrology, KH Elisabethinen, Linz, Austria
                [4 ]Department of Nephrology, Klinikum Rechts der Isar, München, Germany
                [5 ]Department of Nephrology, Institute for Clinical and Experimental Medicine, Prague 4, Czech Republic
                [6 ]Nephrology and Dialysis Department, Regina Margherita Hospital, Torino, Italy
                [7 ]Department of Nephrological Intensive Care, University Jean Monnet, Saint Etienne, France
                [8 ]Department of Nephrology, Hospital del Mar Barcelona, Barcelona, Spain
                [9 ]Department of Nephrology, Charité—Universitätsmedizin Berlin, Berlin, Germany
                [10 ]Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
                Author notes
                Correspondence and offprint requests to: Daniel Abramowicz; E-mail: daniel.abramowicz@ 123456gmail.com ; Twitter handle: @eraedta

                Descartes advisory board collaborators are listed in the Acknowledgements.

                Article
                Publisher ID: gfx365
                DOI: 10.1093/ndt/gfx365
                PMC ID: 6168736
                PubMed ID: 29342289
                SO-VID: 65758439-7dc9-45ba-9de9-41e61f935d18
                Copyright © © The Author(s) 2018. Published by Oxford University Press on behalf of ERA-EDTA.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                Date received : 16 August 2017
                Date accepted : 10 November 2017
                Page count
                Pages: 9
                Categories
                Subject: Reviews
                Subject: Editor's Choice

                ScienceOpen disciplines: Nephrology
                Keywords: allocation,hla antibodies,immunosuppression,machine perfusion,recurrence of fsgs
                Data availability:
                ScienceOpen disciplines: Nephrology
                Keywords: allocation, hla antibodies, immunosuppression, machine perfusion, recurrence of fsgs

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