Transplantation medicine is a rapidly evolving field. Keeping afloat of the published literature to offer the best clinical care to our patients is a daunting task. As part of its educational mission, the Descartes advisory board identified seven topics in kidney transplantation where there has been substantial progresses over the last years: kidney allocation within Eurotransplant; kidney exchange strategies; kidney machine perfusion strategies; the changing landscape of anti-human leukocyte antigen (HLA) antibodies; the new immunosuppressive drugs in the pipeline; strategies for immunosuppression minimization; and the continuous enigma of focal segmental glomerular sclerosis recurrence after transplantation. Here, we have summarized the main knowledge and the main challenges of these seven topics with the aim to provide transplant professionals at large with key bullet points to successfully understand these new concepts.

Department of Nephrological Intensive Care University Jean Monnet Saint Etienne France

Department of Nephrology Charité Universitätsmedizin Berlin Berlin Germany

Department of Nephrology Hospital del Mar Barcelona Barcelona Spain

Department of Nephrology Institute for Clinical and Experimental Medicine Prague 4 Czech Republic

Department of Nephrology KH Elisabethinen Linz Austria

Department of Nephrology Klinikum Rechts der Isar München Germany

Department of Nephrology Medical University of Vienna Vienna Austria

Department of Nephrology Universitair Ziekenhuis Antwerpen Edegem Belgium

Nephrology and Dialysis Department Regina Margherita Hospital Torino Italy

Transplant Unit Royal Infirmary of Edinburgh Edinburgh UK

See more in PubMed

Langer RM, Cohen B, Rahmel A.. History of eurotransplant. Transplant Proc 2012; 44: 2130–2131 PubMed

Frei U, Noeldeke J, Machold-Fabrizii V. et al. Prospective age-matching in elderly kidney transplant recipients—a 5-year analysis of the Eurotransplant Senior Program. Am J Transplant 2008; 8: 50–57 PubMed

Peters-Sengers H, Berger SP, Heemskerk MB. et al. Stretching the limits of renal transplantation in elderly recipients of grafts from elderly deceased donors. J Am Soc Nephrol 2017; 28: 621–631 PubMed PMC

Orandi BJ, Luo X, Massie AB. et al. Survival benefit with kidney transplants from HLA-incompatible live donors. N Engl J Med 2016; 374: 940–950 PubMed PMC

Axelrod D, Segev DL, Xiao H. et al. Economic impacts of ABO-incompatible live donor kidney transplantation: a national study of medicare-insured recipients. Am J Transplant 2016; 16: 1465–1473 PubMed PMC

Orandi BJ, Garonzik-Wang JM, Massie AB. et al. Quantifying the risk of incompatible kidney transplantation: a multicenter study. Am J Transplant 2014; 14: 1573–1580 PubMed

Anderson R, Ashlagi I, Gamarnik D. et al. Finding long chains in kidney exchange using the traveling salesman problem. Proc Natl Acad Sci USA 2015; 112: 663–668 PubMed PMC

Ferrari P, Weimar W, Johnson RJ. et al. Kidney paired donation: principles, protocols and programs. Nephrol Dial Transplant 2015; 30: 1276–1285 PubMed

Massie AB, Gentry SE, Montgomery RA. et al. Center-level utilization of kidney paired donation. Am J Transplant 2013; 13: 1317–1322 PubMed PMC

Gentry SE, Montgomery RA, Segev DL.. Kidney paired donation: fundamentals, limitations, and expansions. Am J Kidney Dis 2011; 57: 144–151 PubMed

Smith JM, Schnitzler MA, Gustafson SK. et al. Cost implications of new national allocation policy for deceased donor kidneys in the United States. Transplantation 2016; 100: 879–885 PubMed

Locke JE, Shelton BA, Reed RD. et al. Identification of optimal donor-recipient combinations among human immunodeficiency virus (HIV)-positive kidney transplant recipients. Am J Transplant 2016; 16: 2377–2383 PubMed PMC

Durand CM, Segev D, Sugarman J.. Realizing HOPE: the ethics of organ transplantation from HIV-positive donors. Ann Intern Med 2016; 165: 138–142 PubMed PMC

Bohmig GA, Fronek J, Slavcev A. et al. Czech–Austrian kidney paired donation: first European cross-border living donor kidney exchange. Transpl Int 2017; 30: 638–639 PubMed

Hosgood SA, Barlow AD, Hunter JP. et al. Ex vivo normothermic perfusion for quality assessment of marginal donor kidney transplants. Br J Surg 2015; 102: 1433–1440 PubMed

Brasile L, Stubenitsky BM, Booster MH. et al. Transfection and transgene expression in a human kidney during ex vivo warm perfusion. Transplant Proc 2002; 34: 2624. PubMed

Moers C, Smits JM, Maathuis MH. et al. Machine perfusion or cold storage in deceased-donor kidney transplantation. N Engl J Med 2009; 360: 7–19 PubMed

Moers C, Pirenne J, Paul A. et al. Machine perfusion or cold storage in deceased-donor kidney transplantation. N Engl J Med 2012; 366: 770–771 PubMed

Watson CJE, Wells AC, Roberts RJ. et al. Cold machine perfusion versus static cold storage of kidneys donated after cardiac death: a UK multicenter randomized controlled trial. Am J Transplant 2010; 10: 1991–1999 PubMed

Buchs JB, Lazeyras F, Ruttimann R. et al. Oxygenated hypothermic pulsatile perfusion versus cold static storage for kidneys from non heart-beating donors tested by in-line ATP resynthesis to establish a strategy of preservation. Perfusion 2011; 26: 159–165 PubMed

Kron P, Schlegel A, de Rougemont O. et al. Short, cool, and well oxygenated—HOPE for kidney transplantation in a rodent model. Ann Surg 2016; 264: 815–822 PubMed

Parikh CR, Hall IE, Bhangoo RS. et al. Associations of perfusate biomarkers and pump parameters with delayed graft function and deceased donor kidney allograft function. Am J Transplant 2016; 16: 1526–1539 PubMed PMC

Nicholson ML, Hosgood SA.. Renal transplantation after ex vivo normothermic perfusion: the first clinical study. Am J Transplant 2013; 13: 1246–1252 PubMed

Jochmans I, Nicholson ML, Hosgood SA.. Kidney perfusion: some like it hot others prefer to keep it cool. Curr Opin Organ Transplant 2017; 22: 260–266 PubMed

Wissing KM, Abramowicz D.. Unacceptable human leucocyte antigens: how to navigate between increased immunological risk and waiting time? Nephrol Dial Transplant 2017; 32: 745–747 PubMed

Zhang R. Donor-specific Abs in kidney transplant recipients. Clin J Am Soc Nephrol 2017; doi: 10.2215/CJN.00700117 [Epub ahead of print] PubMed PMC

Visentin J, Guidicelli G, Bachelet T. et al. Denatured class I human leukocyte antigen Abs in sensitized kidney recipients: prevalence, relevance, and impact on organ allocation. Transplantation 2014; 98: 738–744 PubMed

Konvalinka A, Tinckam K.. Utility of HLA antibody testing in kidney transplantation. J Am Soc Nephrol 2015; 26: 1489–1502 PubMed PMC

Lefaucheur C, Viglietti D, Mangiola M. et al. From humoral theory to performant risk stratification in kidney transplantation. J Immunol Res 2017; 1–8 PubMed PMC

Böhmig GA, Kikic Z, Wahrmann M. et al. Detection of alloantibody-mediated complement activation: a diagnostic advance in monitoring kidney transplant rejection? Clin Biochem 2016; 49: 394–403 PubMed

Yell M, Muth BL, Kaufman DB. et al. C1q-binding activity of de novo donor-specific HLA Abs in renal transplant recipients with and without antibody-mediated rejection. Transplantation 2015; 99: 1151–1155 PubMed

Guidicelli G, Guerville F, Lepreux S. et al. Non-complement-binding de novo donor-specific anti-HLA Abs and kidney allograft survival. J Am Soc Nephrol 2016; 27: 615–625 PubMed PMC

Tait BD, Susal C, Gebel HM. et al. Consensus guidelines on the testing and clinical management issues associated with HLA and non-HLA antibodies in transplantation. Transplantation 2013; 95: 19–47 PubMed

Lefaucheur C, Loupy A, Hill GS. et al. Preexisting donor-specific HLA antibodies predict outcome in kidney transplantation. J Am Soc Nephrol 2010; 21: 1398–1406 PubMed PMC

Nguyen HT, Lim WH, Craig JC. et al. The relative benefits and costs of solid phase bead technology to detect preformed donor specific antihuman leukocyte antigen antibodies in determining suitability for kidney transplantation. Transplantation 2015; 99: 957–964 PubMed

Abramowicz D, Cochat P, Claas FH. et al. European renal best practice guideline on kidney donor and recipient evaluation and perioperative care. Nephrol Dial Transplant 2015; 30: 1790–1797 PubMed

Eurotransplant Annual Report. 2015. http://www.eurotransplant.org/cms/mediaobject.php? file=AR_ET_20153.pdf) (3 July 2017, date last accessed)

Bamoulid J, Staeck O, Halleck F. et al. Immunosuppression and results in renal transplantation. Eur Urol Suppl 2016; 15: 415–442

Wekerle T, Segev D, Lechler R. et al. Strategies for long-term preservation of kidney graft function. Lancet 2017; 389: 2152–2162 PubMed

Bamoulid J, Staeck O, Halleck F. et al. The need for minimization strategies: current problems of immunosuppression. Transpl Int 2015; 28: 891–900 PubMed

Wojciechowski D, Vincenti F.. Current status of costimulatory blockade in renal transplantation. Curr Opin Nephrol Hypertens 2016; 25: 583–590 PubMed

Malvezzi P, Jouve T, Rostaing L.. Costimulation blockade in kidney transplantation: an update. Transplantation 2016; 100: 2315–2323 PubMed PMC

Cordoba F, Wieczorek G, Audet M. et al. A novel, blocking, Fc-silent anti-CD40 monoclonal antibody prolongs nonhuman primate renal allograft survival in the absence of B cell depletion. Am J Transplant 2015; 15: 2825–2836 PubMed

Slade A, Koo P, Espie P. et al. Assessment of safety, pharmacokinetics and pharmacodynamics of a novel anti-CD40 monoclonal antibody, CFZ533 in healthy volunteers. Transplant Int 2015; 28 (Suppl 4): 600

Abou-El-Enein M, Volk HD, Reinke P.. Clinical development of cell therapies: setting the stage for academic success. Clin Pharmacol Ther 2017; 101: 35–38 PubMed

Chhabra AY, Leventhal J, Merchak AR. et al. HSCT based approaches for tolerance induction in renal transplant. Transplantation 2017; 101: 2682–2690 PubMed

Zwang NA, Leventhal JR.. Cell therapy in kidney transplantation: focus on regulatory T cells. J Am Soc Nephrol 2017; 28: 1960–1972 PubMed PMC

http://www.onestudy.org (5 August 2017, date last accessed)

Tang Q, Vincenti F.. Transplant trials with Tregs: perils and promises. J Clin Invest 2017; 127: 2505–2512 PubMed PMC

Valenzuela NM, Reed EF.. Antibody-mediated rejection across solid organ transplants: manifestations, mechanisms, and therapies. J Clin Invest 2017; 127: 2492–2504 PubMed PMC

Roberts DM, Jiang SH, Chadban SJ.. The treatment of acute antibody-mediated rejection in kidney transplant recipients—a systematic review. Transplantation 2012; 94: 775–783 PubMed

Sood P, Hariharan S.. Anti-CD20 blocker Rituximab in kidney transplantation. Transplantation 2017; 102: 44–58 PubMed

Bamoulid J, Staeck O, Halleck F. et al. Advances in pharmacotherapy to treat kidney transplant rejection. Exp Opin Pharmacother 2015; 16: 1627–1648 PubMed

Jordan SC, Lorant T, Choi J. et al. IgG endopeptidase in highly sensitized patients undergoing transplantation. N Engl J Med 2017; 377: 442–453 PubMed

Haller MC, Royuela A, Nagler EV. et al. Steroid avoidance or withdrawal for kidney transplant recipients. Cochrane Database Syst Rev 2016; CD005632 PubMed PMC

Zhang H, Zheng Y, Liu L. et al. Steroid avoidance or withdrawal regimens in paediatric kidney transplantation: a meta-analysis of randomised controlled trials. PLoS One 2016; 11: e0146523. PubMed PMC

Albano L, Banas B, Klempnauer JL. et al. Optimising immunosuppression after kidney transplantation with ADVAGRAF study group. Transplantation 2013; 96: 897–903 PubMed PMC

Mourad G, Glyda M, Albano L. et al.; ADVAGRAF-based immunosuppression regimen examining new onset diabetes mellitus in kidney transplant recipients (ADVANCE) study investigators. Incidence of posttransplantation diabetes mellitus in de novo kidney transplant recipients receiving prolonged-release tacrolimus-based immunosuppression with 2 different corticosteroid minimization strategies: ADVANCE, a randomized controlled trial. Transplantation 2017; 101: 1924–1934 PubMed PMC

Hruba P, Tycova I, Krepsova E. et al. Steroid free immunosuppression is associated with enhanced Th1 transcripts in kidney transplantation. Transpl Immunol 2017; 42: 18–23 PubMed

Prashar R, Venkat KK.. Immunosuppression minimization and avoidance protocols: when less is not more. Adv Chronic Kidney Dis 2016; 23: 295–300 PubMed

Kamar N, Del Bello A, Belliere J. et al. Calcineurin inhibitor-sparing regimens based on mycophenolic acid after kidney transplantation. Transpl Int 2015; 28: 928–937 PubMed

Vincenti F, Rostaing L, Grinyo J. et al. Belatacept and long-term outcomes in kidney transplantation. N Engl J Med 2016; 374: 333–343 PubMed

Ekberg H, Tedesco-Silva H, Demirbas A. et al.; ELITE-Symphony Study. Reduced exposure to calcineurin inhibitors in renal transplantation. N Engl J Med 2007; 357: 2562–2575 PubMed

Nickel P, Presber F, Bold G. et al. Enzyme-linked immunosorbent spot assay for donor-reactive interferon-gamma-producing cells identifies T-cell presensitization and correlates with graft function at 6 and 12 months in renal-transplant recipients. Transplantation 2004; 78: 1640–1646 PubMed

Viklicky O, Hruba P, Tomiuk S. et al. Sequential targeting of CD52 and TNF allows early minimization therapy in kidney transplantation: from a biomarker to targeting in a proof-of-concept trial. PLoS One 2017; 12: e0169624. PubMed PMC

Hodson EM, Willis NS, Craig JC.. Interventions for idiopathic steroid-resistant nephrotic syndrome in children. Cochrane Database Syst Rev 2010; 11: CD003594 PubMed

Puckelwartz M, Schnaper HW.. Keeping the customers stratified: moving toward genetics-based treatment options in childhood NS. Kidney Int 2017; 91: 781–783 PubMed

Bierzynska A, McCarthy HJ, Soderquest K. et al. Genomic and clinical profiling of a national nephrotic syndrome cohort advocates a precision medicine approach to disease management. Kidney Int 2017; 91: 937–947 PubMed

Davin JC. The glomerular permeability factors in idiopathic nephrotic syndrome. Pediatr Nephrol 2016; 31: 207–215 PubMed PMC

Maas RJ, Deegens JK, Wetzels JF.. Permeability factors in idiopathic nephrotic syndrome: historical perspectives and lessons for the future. Nephrol Dial Transplant 2014; 29: 2207–2216 PubMed

Savin VJ, Sharma M.. Plasma ‘factors’ in recurrent nephrotic syndrome after kidney transplantation: causes or consequences of glomerular injury? Am J Kidney Dis 2009; 54: 406–409 PubMed

McCarthy ET, Sharma M, Savin VJ.. Circulating permeability factors in idiopathic nephrotic syndrome and focal segmental glomerulosclerosis. Clin J Am Soc Nephrol 2010; 5: 2115–2121 PubMed

Kronbichler A, Saleem MA, Meijers B. et al. Soluble urokinase receptors in focal segmental glomerulosclerosis: a review on the scientific point of view. J Immunol Res 2016; 2016: 2068691. PubMed PMC

Canaud G, Zuber J, Sberro R. et al. Intensive and prolonged treatment of focal and segmental glomerulosclerosis recurrence in adult kidney transplant recipients: a pilot study. Am J Transplant 2009; 9: 1081–1086 PubMed

Winn MP, Alkhunaizi AM, Bennett WM. et al. Focal segmental glomerulosclerosis: a need for caution in live-related renal transplantation. Am J Kidney Dis 1999; 33: 970–974 PubMed

Lovric S, Ashraf S, Tan W. et al. Genetic testing in steroid-resistant nephrotic syndrome: when and how? Nephrol Dial Transplant 2016; 31: 1802–1813 PubMed PMC

Phelan PJ, Hall G, Wigfall D. et al. Variability in phenotype induced by the podocin variant R229Q plus a single pathogenic mutation. Clin Kidney J 2015; 8: 538–542 PubMed PMC

Machuca E, Hummel A, Nevo F. et al. Clinical and epidemiological assessment of steroid-resistant nephrotic syndrome associated with the NPHS2 R229Q variant. Kidney Int 2009; 75: 727–735 PubMed

A multicentre, patient- and assessor-blinded, non-inferiority, randomised and controlled phase II trial to compare standard and torque teno virus-guided immunosuppression in kidney transplant recipients in the first year after transplantation: TTVguideIT