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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Yet, little is known about current global practices of multidisciplinary meetings for AMR management.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>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; <i>p</i> < 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; <i>p</i> < 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).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>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.</p>\n </section>\n </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 5","pages":""},"PeriodicalIF":1.9000,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/ctr.70167","citationCount":"0","resultStr":"{\"title\":\"Rethinking the Diagnosis and Management of Antibody-Mediated Rejection in Multidisciplinary Transplant Meetings: A Global Survey and Banff Working Group Recommendations\",\"authors\":\"Ruth Sapir-Pichhadze, Medhat Askar, Matthew Cooper, Lynn D. 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Rethinking the Diagnosis and Management of Antibody-Mediated Rejection in Multidisciplinary Transplant Meetings: A Global Survey and Banff Working Group Recommendations
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.
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.
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