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EXPERT OPINION
Year : 2022  |  Volume : 16  |  Issue : 2  |  Page : 145-154

Clinical perspectives towards improving risk stratification strategy for renal transplantation outcomes in Indian patients


1 Department of Nephrology, Medanta Institute of Kidney and Urology, Medanta-The Medicity, Gurugram, Haryana, India
2 Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr. HL Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
3 Department of Transplantation Surgery, KIMS Hospital, Hyderabad, India
4 Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
5 Department of Nephrology, Max Saket Complex, Max Super Speciality Hospital, Saket, Delhi, India
6 Department of Transplantation Surgery, Indraprastha Apollo Hospital, Varanasi, Uttar Pradesh, India
7 Department of Nephrology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
8 Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
9 Department of Nephrology, Banaras Hindu University, Varanasi, Uttar Pradesh, India
10 Department of Nephrology, VPS Lakeshore Hospital, Kochi, Kerala, India
11 Managing Trustee, MOHAN Foundation, Chennai, Tamil Nadu, India
12 Department of Nephrology, Jaslok Hospital and Research Centre, Mumbai, Maharastra, India
13 Department of Nephrology, Yashoda Hospitals, Secunderabad, Telangana, India
14 Department of Nephrology, Institute of Post-Graduate Medical Education and Research, Kolkata, West Bengal, India
15 Department of Nephrology, Max Super Specialty Hospital, Vaishali, Ghaziabad, India
16 Department of Nephrology, Nanavati Max Hospital, Mumbai, Maharastra, India
17 Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
18 Department of Nephrology, Medica Super Specialty Hospital, Kolkata, West Bengal, India
19 Department of Nephrology, Manipal Hospital, Bengaluru, Karnataka, India
20 Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
21 Department of Nephrology, Apollo Hospital, Secunderabad, Telangana, India

Correspondence Address:
Dr. Vivek B Kute
IKDRC-ITS, Ahmedabad, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijot.ijot_28_21

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Graft loss and rejections (acute/chronic) continue to remain important concerns in long-term outcomes in kidney transplant despite newer immunosuppressive regimens and increased use of induction agents. Global guidelines identify the risk factors and suggest a framework for management of patients at different risk levels for rejection; however, these are better applicable to deceased donor transplants. Their applicability in Indian scenario (predominantly live donor program) could be a matter of debate. Therefore, a panel of experts discussed the current clinical practice and adaptability of global recommendations to Indian settings. They also took a survey to define risk factors in kidney transplants and provide direction toward evidence- and clinical experience-based risk stratification for donor/recipient and transplant-related characteristics, with a focus on living donor transplantations. Several recipient related factors (dialysis, comorbidities, and age, donor-specific antibodies [DSAs]), donor-related factors (age, body mass index, type – living or deceased) and transplantation related factors (cold ischemia time [CIT], number of transplantations) were assessed. The experts suggested that immunological conflict should be avoided by performing cytotoxic cross match, flow cross match in all patients and DSA-(single antigen bead) whenever considered clinically relevant. HLA mismatches, presence of DSA, along with donor/recipient age, CIT, etc., were associated with increased risk of rejection. Furthermore, the panel agreed that the risk of rejection in living donor transplant is not dissimilar to deceased donor recipients. The experts also suggested that induction immunosuppression could be individualized based on the risk stratification.


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