Kidney Week 2025 Early Program - Care of Kidney Transplant Candidates and Recipients-Moderated Discussion

Video Transcription

Video Summary

The session opens a Q&A about a patient who received a DCD kidney transplant with delayed graft function. Speakers discuss monitoring and treatment of antibody-mediated rejection (ABMR), noting limited evidence that noninvasive tests (cell-free DNA, gene expression) can track treatment success; donor-specific antibodies (DSA) correlate best with prognosis, but optimal monitoring frequency is unclear. For ABMR with thrombotic microangiopathy (TMA), the panel advises treating ABMR first, considering underlying primary/genetic TMA, and using complement C5 inhibition (e.g., eculizumab) when there is rapid decline and systemic hemolysis. Due to cost and plasmapheresis drug removal, they typically complete plasmapheresis/IVIG first, then start eculizumab. Immunosuppression changes for skin cancer are reviewed: switching from CNI to mTOR may reduce recurrence but has tolerability issues and higher rejection risk; conversion is favored in low-risk patients with limited skin cancers. Protocol biopsy utility remains uncertain; high-risk patients may benefit.

Asset Subtitle

Harini A. Chakkera, Samira S. Farouk, Gaurav Gupta, Vineeta Kumar, Roslyn B. Mannon, Karin A. True, Alexander C. Wiseman

Meta Tag

Module TRX

Speaker FACULTY FACULTY

Keywords

DCD kidney transplant

delayed graft function

antibody-mediated rejection (ABMR) monitoring

donor-specific antibodies (DSA) prognosis

eculizumab complement C5 inhibition for TMA