Eurotransplant Annual Meeting 2015
Kidney meeting
Chair: U. Heemann
Speakers: R. Oberbauer, F. Claas, U. Heemann
Report by: C.M. Tieken
Prof. Oberbauer (Vienna) opened the kidney meeting with his presentation “Systems biology in kidney transplantation”.
Currently, a great number of factors has been tried for the prediction of graft outcome, but so far they failed. The amount of
acute renal failure (ARF) and delayed graft function (DGF) after transplantation over the last 15 years remained the same
(approximately 25%), although there were great improvements regarding preservation, post transplant care and immune
supression. When Oberbauer and colleagues systematically screened the literature, some of the predictors/biomarkers had
more impact on the outcome. miR-182 in particular was involved in a high number of pathways. Thus, the effects of miR-182
were tested in animals which revealed that diminishing the effect of miR-182 might reduce the amount of ARF and DGF after
transplantation. However, more research is required before the benefit of these predictive and therapeutic biomarkers are
clear.
The second presentation “Towards epitope matching in kidney allocation” was given by Prof. Claas (Leiden). In his
presentation, he showed that even with the improved immune suppression, still the number of mismatches has influence on
the outcome as well as sensitization which is important in case of re-transplantation. Moreover, some HLA mismatches will
sensitize more than others, based on the similarities in epitope expression. The ETRL is busy to investigate which matchings
are best for a given patient. The basic problem remaining is the time it takes in the lab to identify the epitopes of a given
donor.
In the last presentation with the title “What about the new allocation?”, Prof. Heemann (Munich) gave a short summary of
the proposed modifications in kidney allocation and the results of a first simulation. A modification of the allocation system
is required. In the current system, the importance of HLA mismatches is outbalanced by long waiting times and balance
points. Over the last ten years, the number of poorly matched patients rapidly increased. The proposed modification grants
a full DR match for the vast majority of patients. In addition, young patients will also receive organs with 2 additional
matches in HLA A/B. Over the last year these changes were simulated and the system readjusted. In the current simulation
balances between the countries were not affected, the number of transports did not increase, but a full DR match was
achieved in all patients and the mismatches were reduced from 2.5 to 1.2. The next steps will be a closer look on the
individual groups of patients.
Report Annual Meeting 2015 | Eurotransplant
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