DOI: http://dx.doi.org/10.18203/2349-3933.ijam20214144

Current practices in the management of kidney transplant rejection: an Indian perspective

Sharad Sheth, Abi Abraham, Georgi Abraham, Sampath Kumar

Abstract


Renal diseases like chronic kidney disease (CKD) and end-stage renal disease (ESRD) are a major healthcare burden in developing countries like India. Kidney transplantation is considered to be the most viable treatment option for such patients. In comparison to dialysis, renal transplantation is associated with reduced mortality and improved quality of life. However, a major challenge experienced in transplant procedures is transplant rejection. Four virtual advisory board meetings involving 30 nephrology experts were conducted to discuss the current therapeutic landscape of kidney transplant rejection in India and subsequent practice-based insights of the experts were garnered. The experts concurred on the need for appropriate screening including immunological profiling, diagnosis, and management of candidates for transplantation. While immunosuppressive therapy and strategies like plasmapheresis, intravenous immunoglobulin, corticosteroids, and rituximab have been well established in the treatment of transplant rejection, novel and emerging treatment modalities like interleukin-6 antagonists, imlifidase or complement inhibitors have shown promise and should be considered. Increased awareness among physicians about the development of newer immunosuppressive regimens with lower side effects that may improve long-term outcomes of kidney transplantation is warranted.


Keywords


Kidney transplant rejection, Antibody-mediated rejection, Crossmatch, Immunosuppressive therapy, Induction, Maintenance immunosuppression

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References


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