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European survey on clinical practice of detecting and treating T-cell mediated kidney transplant rejection
Background of the project.
Since the beginning of kidney transplantation, first-line treatment of acute rejection has consisted of high-dose pulse corticosteroids. However, high-dose corticosteroids are not always efficacious at reversing rejection. In 1998, Thymoglobulin was approved by the US FDA for the treatment of acute rejection.
In Europe, Thymoglobulin is approved by the national authorities of the member states.
The last consensus forum defining efficacy endpoints for the assessment of anti-rejection therapy was in 1995 and relied primarily on renal functional criteria. As the definitions of rejection, insights in pathophysiology and outcome, and the treatment options have changed importantly over the past 25 years, a new consensus on more recent data is needed.
In line with the 2009 KDIGO rejection treatment guidelines, two recent physician surveys (performed in USA and Canada) indicate that the majority use steroids as first-line therapy for T-cell mediated rejection (TCMR) and primarily follow renal function as the guide to treatment efficacy.
However, European data on the current clinical practice of treating and follow-up after (borderline) TCMR are currently lacking. As the clinical practice in Europe is likely different from Canada and the USA, enriching the debate and adapting consensus to the current European reality is necessary.
Therefore, EKITA (the European Kidney Transplant Association, section of ESOT), has launched this survey to determine the current practice of detection and treatment of (borderline) TCMR, both in indication and in protocol biopsies. Your answers will only be reported in the aggregate.
