Transummit talks: Improving Long-Term Outcomes in Kidney Transplant: Recent Advances
The need of the hour for enhanced renal transplant is survival of both patient and graft and the requirement of a functional graft with good quality of life.
Important interventions for better long-term outcomes
Before transplantation, it is necessary for pre-emptive transplant via early referral before the condition of the patient worsens, judicious use of KDPI that is using marginal kidneys on patients who may not need them for a prolonged time period, utilize all kidneys as much as possible, minimize ischemia and use paired exchange transplant. After transplantation, it is necessary to monitor, detect and treat incidents like acute T cell-mediated rejection, Acute antibody-mediated rejection, delayed graft function, post-transplant viral infections, recurrent and de novo diseases after transplantation and drug-induced toxicity.
Breakthrough Findings in the Survival of Kidney Transplants.
Intervention in subclinical inflammation also had an impact on the long-term outcome of transplants. Before subclinical rejection, which is also called borderline rejection, the graft presents with inflammation when there is only minimal rejection. This inflammation, termed subclinical inflammation, can be caught at the right time and controlled using a dose of steroids and some slight changes in the immunosuppressive drugs regimen.
Transplant tolerance could be induced by donor hematopoietic cell chimerism due to the laborious process associated with it. However, this is not used widely.
In a discussion with the speaker, Prof. (Dr.) Abhinav Humar, it was reviewed that from his experience at the University of Minnesota, even with the doses of steroids, there have been significantly poor outcomes in patients three years after transplantation. Hence, it is always beneficial to give the patients one dose of steroids and then leave them steroid-free for life.
Eplet matching is not difficult. It requires a good set-up with a registry for all the donors and recipients who could be matched and paired. This initiative must be done at the national level, probably with help of the government.
Eplet matching and uncoupling of the donors require an extensive set-up. Better preservation of the harvested organ is a possibility in India. Using machine perfusion can significantly benefit the long-term outcome.
The patients must be screened quite frequently. If there is a positive marker in the first six months, the frequency of the screening must be increased to prevent the rising titer.
