Editorial: Future challenges and directions in determining allo-immunity in kidney transplantation

Canadian Kidney Transplant Recipients', Transplant Candidates', and Caregivers' Perspectives on Precision Medicine and Molecular Matching in Kidney Allocation: A Qualitative Analysis

Background

Antibody-mediated rejection (AMR) is an important cause of kidney transplant loss. A new strategy requiring application of precision medicine tools in transplantation considers molecular compatibility between donors and recipients and holds the promise of improved immunologic risk, preventing rejection and premature graft loss.

Objective

The objective of this study was to gather patients' and caregivers' perspectives on molecular compatibility in kidney transplantation.

Design

Individual semi-structured interviews.

Setting

The Centre hospitalier de l'Université de Montréal (CHUM) and McGill University Health Centre (MUHC) kidney transplant programs.

Participants

Kidney transplant candidates, kidney transplant recipients, and caregivers.

Methods

Twenty-seven participants took part in semi-structured interviews between July 2020 and November 2021. The interviews were digitally recorded, transcribed, and analyzed using the qualitative description approach.

Results

Participants had different levels of knowledge about the kidney allocation process. They expressed trust in the system and healthcare professionals. They indicated that a fair organ allocation system should strive to maximize graft survival as it would decrease the demand for deceased donor kidneys and allow more patients to access transplantation. Molecular matching and precision medicine were seen as important improvements in the kidney transplant allocation process given their potential to improve graft survival and decrease the need for retransplantation. However, participants were concerned about increased waiting times that may negatively impact some patients upon implementation of molecular matching. To address these concerns, participants suggested integrating safeguards in the form of maximum waiting time for molecularly matched kidneys.

Limitations

This study was conducted in the province of Quebec most of the participants were white and highly educated. Consequently, the results could not be generalizable to other populations, including ethnic minorities.

Conclusions

Molecular matching and precision medicine are viewed as promising technologies for decreasing the incidence of AMR and improving graft survival. However, further studies are needed to determine how to ethically integrate this technology into the kidney allocation scheme.

Trial registration

Not registered.

Canadian Kidney Transplant Professionals' Perspectives on Precision Medicine and Molecular Matching in Kidney Allocation

Background

Antibody-mediated rejection is an important cause of kidney transplant loss. A new strategy requiring application of precision medicine tools in transplantation considers molecular compatibility between donors and recipients and holds the promise of improved immunologic risk, preventing rejection and premature graft loss. The objective of this study was to gather Canadian transplant professionals' perspectives on molecular compatibility in kidney transplantation.

Methods

Seventeen Canadian transplant professionals (14 nephrologists, 2 nurses, and 1 surgeon) participated in semistructured interviews in 2021. The interviews were digitally recorded, transcribed, and analyzed using the qualitative description approach.

Results

Participants identified fair access to transplantation as the most important principle in kidney allocation. Molecular compatibility was viewed as a promising innovation. However, participants were concerned about increased waiting times, negative impact on some patients, and potential problems related to the adequacy of information explaining this new technology. To mitigate the challenges associated with molecular matching, participants suggested integrating a maximum waiting time for molecular-matched kidneys and expanding the program nationally/internationally.

Conclusions

Molecular matching in kidney transplantation is viewed as a promising technology for decreasing the incidence of antibody-mediated rejection and improving graft survival. Further studies are needed to determine how to ethically integrate this technology into the kidney allocation algorithm.