Linee guida

We recommend starting a combination of immunosuppressive medications before, or at the time of, kidney transplantation. (1A)

We suggest including induction therapy with a biologic agent as part of the initial immunosuppressive regimen in KTRs. (2B)

We suggest using a lymphocyte-depleting agent, rather than an IL2-RA, for KTRs at high immunologic risk. (2B)

We recommend biopsy before treating acute rejection, unless the biopsy will substantially delay treatment. (1C)

We recommend kidney allograft biopsy for all patients with declining kidney function of unclear cause, to detect potentially reversible causes. (1C)

We recommend kidney allograft biopsy when there is a persistent, unexplained increase in serum creatinine. (1C)

We suggest kidney allograft biopsy when serum creatinine has not returned to baseline after treatment of acute rejection. (2D)

We suggest kidney allograft biopsy every 7–10 days during delayed function. (2C)

We suggest kidney allograft biopsy if expected kidney function is not achieved within the first 1–2 months after transplantation. (2D)

We suggest kidney allograft biopsy when there is:

• new onset of proteinuria; (2C)
• unexplained proteinuria ≥3.0 g per gram creatinine or ≥3.0 g/24hr; (2C)
• de novo donor-specific antibodies. (2C)

We suggest that the option of performing kidney protocol biopsies is considered when organ quality evaluation and immune monitoring is deemed useful for clinical decision making purposes (2D)

We recommend starting a combination of immunosuppressive medications before, or at the time of, kidney transplantation. (1A)

We suggest including induction therapy with a biologic agent as part of the initial immunosuppressive regimen in KTRs. (2B)

We suggest using a lymphocyte-depleting agent, rather than an IL2-RA, for KTRs at high immunologic risk. (2B)

We suggest treating antibody-mediated acute rejection with one or more of the following alternatives, with or without corticosteroids (2C):

• plasma exchange or immunoadsorption;
• intravenous immunoglobulin;
• anti-CD20 antibodies or other B cell modulators
• anti-plasma cell agents
• lymphocyte-depleting
• Complement blockers and/or splenectomy in selected cases

For patients who have a rejection episode, we suggest adding mycophenolate if the patient is not receiving mycophenolate or azathioprine, or switching azathioprine or mTOR-inhibitors to mycophenolate and switching from cyclosporine to tacrolimus. (2D)