Kidney Week 2025 Annual Meeting-Best in Show: Literature Review in Kidney Transplantation

Video Transcription

Video Summary

The session opened with introductions and a tribute to Dr. Martin “Roy” First, a pioneering transplant nephrologist, former AST president, mentor, and passionate advocate for underserved patients. Speakers then presented “Best in Show” highlights from 2024–2025 kidney transplant literature across clinical, basic, translational, and policy domains, with audience Q&A and voting planned.<br /><br />Clinical updates focused on long-term allograft survival and antibody-mediated injury. Dr. John Gill emphasized emerging roles for innate immunity—particularly NK cells—and reviewed a small phase 2 randomized NEJM trial of anti-CD38 (felzartamab) in late antibody-mediated rejection showing improved biopsy inflammation and stabilized eGFR versus placebo, with signals suggesting NK-cell involvement. He also summarized a large multinational biopsy reclassification study comparing Banff 2019 vs 2022, showing that newly defined microvascular inflammation categories (including DSA-/C4d- MVI) correlate with worse graft outcomes, plus complementary single-center studies exploring heterogeneity in “MVI” and “probable AMR.”<br /><br />Basic science highlights included immunosenescence and sex-based immune differences. Dr. Diane McKay reviewed evidence that older donor organs can transfer senescent cells and inflammatory signals to young recipients in animal models, mitigated by donor senolytics, and discussed limited clinical data suggesting age/sex interactions in post-transplant immune markers and infection risk. She also warned about worsening U.S. research funding conditions.<br /><br />Translational talks covered innate histocompatibility (SIRPα–CD47 macrophage signaling), a mutant IL-2 strategy to selectively expand Tregs and promote tolerance in preclinical models, and landmark clinical xenotransplantation reports of gene-edited porcine kidneys supporting physiologic function in humans.<br /><br />Health services/policy discussion centered on rising kidney nonuse, allocation “out of sequence,” unintended consequences of broader sharing (longer cold time, more DGF, possible worse graft survival), impacts of race-neutral eGFR policies, and ongoing tensions around multi-organ allocation and equity.

Asset Subtitle

Moderator(s): Michelle Josephson, Alexander Wiseman

Presentation(s):

Clinical Science Update - John Gill
Basic Science Update - Dianne McKay
Translational Science Update - Leonardo Riella
Health Services Research and Policy Update - Deirdre Sawinski

Meta Tag

Date 11/8/2025

Pathway 1 Kidney Transplantation

Pathway 2 Kidney Biology and Physiology

Session ID 507331

Keywords

kidney transplantation

allograft survival

antibody-mediated rejection

microvascular inflammation

Banff 2022 classification

donor-specific antibodies

C4d-negative AMR

natural killer cells

anti-CD38 felzartamab

immunosenescence

senolytics

SIRPα-CD47 signaling

regulatory T cells

mutant IL-2 therapy

gene-edited porcine kidney xenotransplantation