Rethinking the Diagnosis and Management of Antibody-Mediated Rejection in Multidisciplinary Transplant Meetings: A Global Survey and Banff Working Group Recommendations

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2025-04-28 DOI:10.1111/ctr.70167

Ruth Sapir-Pichhadze, Medhat Askar, Matthew Cooper, Lynn D. Cornell, Emanuele Cozzi, Darshana M. Dadhania, Fritz Diekmann, Aiko P. J. de Vries, Carrie A. Schinstock, Robert P. Carroll, Ahmad Abdelrehim, Geliang Gan, Yanhong Deng, Sami Alasfar, Serena M. Bagnasco, Ibrahim Batal, Klemens Budde, Marian C. Clahsen-van Groningen, Vanderlene L. Kung, Fritz Lower, Mariana Seija, Edward Kraus, Maarten Naesens, Laurine M. Bow, the Banff Antibody-Mediated Injury Working Group

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Abstract

Introduction

The diagnosis of antibody-mediated rejection (AMR) requires input from several transplant professionals. Bringing clinical and laboratory experts together may help standardize care. Yet, little is known about current global practices of multidisciplinary meetings for AMR management.

Methods

The Banff Antibody-Mediated Injury Working Group approached professional societies worldwide to distribute a survey on the availability, content, participants, perceived value, and barriers to the implementation of multidisciplinary meetings.

Results

Four hundred two transplant professionals from six continents caring for kidney (90.55%), liver (21.14%), pancreas (20.65%), heart (15.17%), and lung (14.18%) transplant recipients participated in the survey, and 302 (75.12%) reported attending multidisciplinary meetings. Multidisciplinary meetings were more prevalent in academic centers, in high- versus low-to-middle-income regions (81.03% and 65.99%, respectively; p < 0.001), and in mid-to-large size transplant programs compared to smaller programs. Perceived value included continued professional development (97.68%) and trainee education (95.70%). AMR was reported to be discussed at these meetings by 217 respondents with case presentations reviewing patient characteristics, histology, and HLA antibody data. A third of the respondents reviewed non-HLA/pathogenic autoantibodies and/or molecular diagnostics, with the latter being more frequently applied in high- versus low-to-middle-income regions (46.71% and 12.31%, respectively; p < 0.001). AMR case presentations allowed diagnosis revision, actionable management plans and were perceived as improving care. The primary barrier to the implementation of multidisciplinary meetings (63.27%) was the unavailability of transplant professionals (e.g., transplant immunologists).

Conclusion

Facilitating multidisciplinary meetings through the remote participation of pertinent experts and incentivizing participation through remuneration, protected time, or continued medical education may help standardize AMR diagnosis and harmonize its management.

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重新思考多学科移植会议中抗体介导的排斥反应的诊断和管理：一项全球调查和班夫工作组建议

抗体介导的排斥反应（AMR）的诊断需要几个移植专业人员的投入。将临床和实验室专家聚集在一起可能有助于标准化护理。然而，目前对AMR管理的多学科会议的全球实践知之甚少。方法班夫抗体介导损伤工作组与世界各地的专业协会联系，发布了一份关于多学科会议的可获得性、内容、参与者、感知价值和实施障碍的调查。结果来自六大洲的4200名肾（90.55%）、肝（21.14%）、胰（20.65%）、心（15.17%）、肺（14.18%）移植专业人员参与了调查，302名（75.12%）报告参加了多学科会议。与中低收入地区相比，多学科会议在学术中心更为普遍（分别为81.03%和65.99%）；p & lt;0.001)，并且在中大型移植项目中与小型移植项目相比。感知价值包括持续专业发展（97.68%）和培训生教育（95.70%）。据报道，在这些会议上，217名应答者通过病例报告回顾了患者特征、组织学和HLA抗体数据，讨论了AMR。三分之一的受访者回顾了非hla /致病性自身抗体和/或分子诊断，后者在高收入地区比中低收入地区更频繁地应用(分别为46.71%和12.31%；p & lt;0.001)。AMR病例报告允许诊断修订，可操作的管理计划，并被视为改善护理。实施多学科会议的主要障碍（63.27%）是缺乏移植专业人员（如移植免疫学家）。结论通过相关专家远程参与促进多学科会议，并通过奖励、保护时间或继续医学教育激励参与，有助于规范AMR诊断和协调其管理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.