ENGAGE II – International Workshop on Immunomodulation and Desensitisation

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

ENGAGE II working group published an updated definition of sensitisation in candidates for solid organ transplantation (Bestard et al., Transpl Int, 2021, 34: 1005–1018) 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. Building on this first step, the ENGAGE II working group performed a systematic search evaluating the Induction Therapies, Antibody Removal Strategies and New Biological Drugs and Maintenance immunosuppression, and these data have been synthesised in a white paper that has been the basis for the rationale of the following step, the ENGAGE consensus project.

The project, based on the Delphi methodology, was aimed at obtaining a consensus among European experts on desensitization and immunomodulation of kidney recipients, according to defined pre-transplantation patient humoral risk profiles. Desensitisation strategies are employed before the transplantation to prevent hyperacute rejection in patients with high levels of preformed DSA and, therefore, increase the transplant candidate’s access to transplantation. In contrast, the modulation of induction and maintenance immunosuppression (including the use of Antibody Removal Strategies) can be adjusted from day 0 onward according to the risk profile of the recipient in order to reduce his risk of subsequent AMR and graft loss.

The ENGAGE II working group final paper titled “European consensus on the management of sensitized kidney transplant recipients: a Delphi study” was accepted for publication on Transplant International (TI), in March 2024.

This project is possible thanks to unrestricted grants from Hansa.