Through a glass darkly: seeking clarity in preventing late kidney transplant failure

Establishment of a global virtual laboratory for transplantation: a symposium report

Advancing the field of transplantation by developing improved and novel treatment strategies will require a detailed understanding of changes and adaptations of alloimmunity, both over the short-term and long-term. Presently, we rely on traditional measures that may not optimally reflect benefits of new treatments. Thus, collecting reliable basic information about changes of the immune response along the entire posttransplantation course will improve our understanding of how immune mechanisms evolve and guide the introduction of novel clinical approaches. The gathering of good quality data from transplant recipients in various clinical trials will require immune monitoring that is reliable and comparable so that large sets of information from individual trials can be confidently analyzed to reach rigorous conclusions. A uniform standard of testing is thus a prerequisite toward this goal. Based on the assumption that the transplantation community will in general be supportive of this concept, this meeting proposed establishing a global virtual laboratory as a means of developing and disseminating detailed and rigorous protocols for the monitoring of alloimmune responses.

Modernization of Chronic Allograft Injury Research: Better Biomarkers, Better Studies, Better Outcomes

Despite dramatic improvements in acute rejection rates and short-term allograft survival, long-term allograft survival remains unchanged in the modern era, largely due to chronic allograft injury, a progressive disease that is common across all solid organ transplantation but has no proven treatment. Studies of novel diagnostic and therapeutic strategies for chronic allograft injury have been relatively sparse, in part due to the time and expense required to conduct traditional long-term clinical studies of a variably progressive disease. In this article, we review the pathophysiology of chronic allograft injury, including recent insights into key mechanisms of the disease. We discuss the barriers to progress in chronic allograft injury research and present alternative approaches to study design that could accelerate improvements in diagnosis, prevention, or treatment of the disease. We integrate these approaches with emerging biomarkers and surrogate endpoints into a model clinical study of chronic renal allograft injury, providing a framework for modern study design in solid organ transplantation.