On the 3rd February 2016, a group of 20 kidney transplant recipients, donors and professionals took part in a consensus workshop at the Royal College of Surgeons of England, in London. The group considered the top 25 ranked treatment uncertainties from the PSP prioritisation survey, and after much lively debate agreed a top ten list of priorities for the future of research in kidney transplantation.
The top ten priorities agreed by the group were as follows:
- What is the best way to treat vascular or antibody-mediated acute rejection?
- How can immunosuppression be personalised to the individual patients to improve the results of transplantation?
- How can we prevent sensitisation in patients with a failing transplant, to improve their chances of another successful transplant (e.g. removal of the transplant, withdrawal of immunosuppressive medicines or continuation of these medicines?)
- Can we improve monitoring of the level of immunosuppression to achieve better balance between risk of rejection and side effects? (e.g. T-cell or B-cell ELISPOT, point-of-care tacrolimus monitoring, MMF monitoring)
- How can we improve transplant rates in highly sensitised patients?
- What are the long-term health risks to the living kidney donor?
- How can we encourage tolerance to the transplant to prevent or reduce the need for immunosuppression? (e.g. by use of T-regulatory cells, induction of haemoxygenase 1)
- What is the best combination of immunosuppressive drugs following kidney transplantation? (e.g. azathioprine or mycophenolate, belatacept, generic or proprietary (brand-name) drugs)
- What techniques to preserve, condition and transport the kidney before transplantation allow increased preservation times and/or improve results? (e.g. machine perfusion, normothermic reconditioning, addition of agents to the perfusate)
- Can bioengineered organs be developed to be as safe as human-to-human transplants? How can this be achieved?
We would like to extend a big thank-you to all those who took part in the PSP process, including the steering group, all those who responded to the surveys and the group who attended the final workshop including Karen Casey, Rebecca Farwell, Sue Lyon, Nick Palmer, Alistair Reid, Tracey Rose, Chris Walton, David Wilson, Lisa Wynn, Rasheed Ahmad, Pippa Bailey, Chris Ide, Steven Sachs, Bynvant Sandhu and Michelle Willicombe.