Kidney Week 2025 Annual Meeting-Transplantation: Clinical Controversies in Donation, Access, Monitoring, and Treatment

Video Transcription

Video Summary

The session covered multiple clinical controversies in kidney transplantation, spanning organ donation, waitlisting policy, allocation practices, living donation barriers, elderly recipients, rejection monitoring, novel ABMR therapy, post-transplant outcomes in glomerular disease, and genetics in donor evaluation.<br /><br />A Taiwan team presented the “Hear My Last Wish” initiative, using information/communication technology and “voice-print” donor cards that store a recorded message plus consent to help families honor donation wishes during the narrow retrieval window. After launch (Nov 2023) and an AI-supported public campaign (2024), registrations and completed consents rose substantially, though speakers noted legal, cultural, and cybersecurity considerations.<br /><br />University of Michigan investigators proposed adding kidney-failure progression risk (KFRE) to the US waitlisting threshold (currently eGFR <20). In Veterans data, KFRE-based eligibility identified younger, more racially diverse “fast progressors” and may improve equity, though discussants emphasized that late referral and post-dialysis listing disparities would remain.<br /><br />Columbia researchers analyzed “out-of-sequence” (rescue) deceased donor kidney allocation. High-volume centers often bypassed top local candidates; younger and non-preemptively listed patients were more likely skipped, and many later received higher-KDPI kidneys or had adverse waitlist outcomes. Greater transparency (e.g., notifying skipped patients) was suggested.<br /><br />Houston Methodist highlighted lost living-donor opportunities due to BMI ≥35, documenting many donor deferrals and associated longer waits and worse outcomes for intended recipients, motivating structured weight-loss interventions.<br /><br />Mayo Arizona reported that carefully selected recipients aged ≥75 had comparable short-term graft and patient outcomes to ages 65–74, with later divergence driven mainly by death with functioning graft—supporting individualized rather than age-based exclusion.<br /><br />Other talks addressed multi-biomarker/ML approaches to personalize subclinical rejection risk; a small Korean trial of bone marrow–derived mesenchymal stem cells for chronic active ABMR suggesting stabilization signals but infection risk; UK RADAR registry data linking 1-year proteinuria to markedly worse graft survival in several GN diagnoses; and an international registry showing variable genetic-testing practices in living donor evaluation, with results (notably APOL1 and other variants) affecting donor acceptance.

Asset Subtitle

Moderator(s): Nada Alachkar, Sapna Shah

Presentation(s):

Leveraging Information and Communication Technology and Voiceprint Technology to Promote Posthumous Organ Donation in Taiwan: Preliminary Results of the "Hear My Last Wish" Initiative - Hung Bin Tsai
Optimizing Timing for Kidney Transplant Wait-Listing - Jennifer Bragg-Gresham
Who Gets Skipped? Characterizing Within-Center Placement of Out-of-Sequence Deceased-Donor Kidneys - Emma Tucker
Lost Opportunities for Living Donation: Is It Time for Weight-Loss Interventions for Motivated Potential Donors with High Body Mass Indices? - Thomas Potter
Transplanting Beyond 75: A Decade of Outcomes in Very Elderly Patients - Sami Alasfar
Effect of Biomarkers and Patient-Specific Factors on Kidney Rejection Risk - Akhil Singla
Clinical Trial Assessing the Safety and Efficacy of Human Bone Marrow-Derived Allogeneic Mesenchymal Stem Cell Therapy for Chronic Active Antibody-Mediated Rejection in Kidney Transplant Recipients - Hyeran Park
Outcomes of Kidney Transplantation in Primary Glomerulonephritis (GN) Mapped to Post-Transplant Proteinuria in the United Kingdom (UK) RaDaR Registry - Daniel Gale
Living-Donor Kidney Transplantation in the Genomics Era: Insights from an International Registry - Yasar Caliskan

Note: Continuing education credits are not being offered for this session.

Meta Tag

Date 11/8/2025

Pathway 1 Kidney Transplantation

Session ID 519904

Keywords

kidney transplantation controversies

voice-print donor card

organ donation ICT initiative

KFRE-based waitlisting eligibility

eGFR <20 waitlist threshold

out-of-sequence kidney allocation

allocation transparency for skipped candidates

living donor BMI ≥35 deferral

structured donor weight-loss interventions

transplant outcomes in recipients ≥75

subclinical rejection biomarkers and ML

genetic testing in living donor evaluation (APOL1)