Renal diseases such as chronic kidney disease (CKD) and end-stage renal disease (ESRD) are a major healthcare burden in developing countries such as India. Kidney transplantation is considered to be the most viable treatment option for such patients. In comparison to dialysis, renal transplantation is associated with reduced mortality and improved quality of life. However, a major challenge experienced in transplant procedures is transplant rejection. Four virtual advisory board meetings involving 30 nephrology experts were conducted to discuss the current therapeutic landscape of kidney transplant rejection in India, and subsequent practice-based insights of the experts were garnered.
The experts concurred on the need for appropriate screening, including immunological profiling, diagnosis, and management of candidates for transplantation. While immunosuppressive therapy and strategies such as plasmapheresis, intravenous immunoglobulin, corticosteroids and rituximab have been well established in the treatment of transplant rejection, novel and emerging treatment modalities such as interleukin-6 antagonists, imlifidase or complement inhibitors have shown promise and should be considered. Increased awareness among physicians about the development of newer immunosuppressive regimens with lower side effects that may improve long-term outcomes of kidney transplantation is warranted.