ENGAGE Consensus Project

The EuropeaN Guidelines for the mAnagement of Graft rEcipients (ENGAGE) is an initiative from the European Society for Organ Transplantation (ESOT).

The ENGAGE project is dedicated to providing a general global view of the current management of sensitised kidney recipients and to establish a consensus on how desensitisation and immunomodulation strategies should be combined according to a patient’s risk of humoral rejection.

The ENGAGE I working group, in their 2021 publication (Bestard et al., Transpl Int, 2021, 34: 1005–1018), introduced an updated definition of sensitization in candidates for solid organ transplantation, suggesting that data from the patient’s “immunological” history should be integrated with single-antigen bead assay and cytotoxic (CDC) and flow cytometry cross-matching, to enable their risk of antibody mediated rejection (AMR) and graft loss to be estimated and stratified into one of five categories.

A series of statements related to clinical practice in the context of sensitised kidney transplant recipients were categorised in relation to the risk stratification proposed by ENGAGE I. The ENGAGE II working group performed a systematic data search to formulate, discuss, and vote on these statements regarding the current management of sensitised kidney recipients. This process was carried out using the Delphi method (the Delphi method involves two waves of questionnaires with several statements, and panel members are asked to vote on their agreement with the statement).

The project commenced in December 2021 and reached its culmination in November 2022, when the results of the two waves of consultations were presented at TLJ 3.0, which took place in Prague, Czech Republic, on November 13-15, 2022. A copy of the highlights of the meeting that was held in Prague, is available at this link.

The final consensus manuscript was submitted for publication to a peer-reviewed journal in Q4 2023. The link to the final published manuscript is available here below.

In 2025, building on the insights gained from ENGAGE I and ENGAGE II, the ENGAGE III working group focusses on the treatment of ABMR episodes by: 

• Conducting a comprehensive literature review to identify optimal treatment strategies. 

• Publishing a state-of-the-art review summarising the current evidence and practice. 

• Organising a dissemination webinar to share findings with the broader transplant community. 

• Developing potential guidelines and recommendations for clinical management based on available evidence. 

The expected outcomes of this project are: 

• Enhanced understanding of optimal ABMR treatment strategies. 

• A well-documented state-of-the-art review providing a roadmap for future research and clinical applications. 

• Increased awareness and dissemination of best practices through webinars and publications. 

• Contribution towards the development of European guidelines for ABMR management.