Progress in improving long term transplant survival has been unsatisfactory so far.
Major hurdles to achieve optimal long-term graft survival are represented by the limits of the current immunosuppressive treatment regimens, and by the decreased quality of the available organs.
Current immunosuppressive treatment regimens may induce complications related to excessive T-cell immunosuppression, such as infections and malignancies, which represent major causes of death with a functioning graft. On the other hand, the development of chronic rejection is primarily related to an inadequate control of T-cell mediated alloreactivity post-transplantation. Indeed, the development of donor-specific anti-HLA antibodies, which are regarded as the main cause of renal graft failure, is mainly a consequence of the inadequate control of T-cell mediated alloreactivity. Besides anti-HLA antibodies, there is increasing evidence that acute and chronic graft damage can induce the development of non-HLA autoantibodies, that might eventually amplify graft injury in the long term.
The decreased quality of the available organs caused by organs shortage over the past decades has resulted in the need to widen the criteria for donation. Despite being considered unsuitable until not long ago, elderly donors and donors after brain death have now become major sources for solid organ transplantation. However, fragile organs do not recover easily from the parenchymal damage resulting from ischemic injury, calcineurin inhibitors toxicity, or rejection. New treatment strategies are therefore required to optimize the management of these organs.
This course will provide exciting insights on the modern perspectives on how to improve long term transplant outcomes. It will provide the most updated overview of the factors eliciting and maintaining antibody mediated alloreactivity, providing insights on how to prevent these reactions through organ preservation and fine tuning of the immunosuppressive regimens. It will also educate the attendees on new approaches aimed at minimizing or stopping immunosuppression without increasing the risk of chronic rejection in the long term. Furthermore, it will elucidate about the new strategies for expanding criteria in organ donation while avoiding rejection risks. Finally, the audience will be presented with real life cases of organ acceptance and management.
Julio Pascual, Spain
Klemens Budde, Germany
Josep M. Grinyó, Spain
Lionel Rostaing, France
Daniel Abramowicz, Belgium
Umberto Maggiore, Italy
Rainer Oberbauer, Austria