WEBINAR: Towards a consensus on the management of microvascular inflammation after kidney transplantation

Project description:
Microvascular inflammation (MVI) is one of the most frequent and clinically relevant histological patterns observed in kidney transplantation. Yet, its management remains highly heterogeneous, reflecting both the complexity of its underlying immunopathology and the limited evidence supporting current treatment strategies.

Over the last decade, major advances have reshaped our understanding of the immunopathology underlying MVI. Antibody-mediated rejection (AMR) is increasingly recognized as a heterogeneous process, in which donor-specific antibodies (DSA) may cause endothelial injury through distinct, and potentially overlapping, mechanisms, including antibody-dependent cellular cytotoxicity (ADCC) and complement activation. At the same time, accumulating evidence indicates that NK-cell activation through DSA-independent “missing-self” recognition can also contribute to MVI. Importantly, these pathways are not mutually exclusive and may coexist and interact, providing a biological framework that may help explain the marked heterogeneity observed among patients presenting with similar histological lesions.

In parallel, the therapeutic landscape is rapidly evolving. Treatment has progressively moved beyond strategies primarily aimed at reducing circulating DSA levels, such as IVIg and plasma exchange, towards approaches targeting specific effector mechanisms, including complement inhibition and modulation of NK-cell responses, for example through CD38-targeting strategies.

Despite these advances, there is still no widely accepted or standardized approach to the treatment of MVI. The increasing complexity of its immunopathology, together with a rapidly expanding therapeutic arsenal, makes it increasingly important to establish a shared framework to guide clinical decision-making.

This is the rationale for ENGAGE 3: to systematically review the available evidence and, where evidence remains insufficient, develop a European expert consensus on the management of microvascular inflammation, whether DSA-mediated or DSA-independent.

Scientific Leads:

• Olivier Thaunat (France)
• Georg A. Böhmig (Austria)

Programme:

• 18:00 Unmet needs and changing perspectives in the management of MVI – Klemens Budde (Germany)
• 18:20 ENGAGE 3: The Delphi survey and results of the first round –  Matthias Diebold (Switzerland)
• 18:40 Discussion with the audience and preparation of the second Delphi round – All speakers