DESCARTES - Developing Education Science and Care for Renal Transplantation in European States

DESCARTES actively contributed in the creation of the special web page pertaining to global outbreak of COVID-19

New publication in NDT!
How should I manage immunosuppression in a kidney transplant patient with COVID-19? An ERA-EDTA DESCARTES expert opinion

DESCARTES is organising the CTDay 20202 – Patient Management and Empowerment in the Post COVID-19

MISSION

The ERA-EDTA Council officially approved the creation of a working group dedicated to renal transplantation. Its creation is mainly due to the following reasons:
– Kidney transplantation is a relevant part of Nephrology. Indeed, nearly 50% of patients with primary kidney failure live with a kidney transplant in Europe. Therefore, increasing kidney transplantation visibility and disseminating its knowledge may benefit the whole nephrological community.
– The knowledge about kidney transplantation and current standard practices in kidney transplantation varies between European countries and nephrologists and objective, unbiased educational activities may help to further increase the post-transplant outcome in European patients.
– In Europe several research groups dealing with renal transplantation exist. Their activity can benefit from a mutual exchange of knowledge and expertise liaising with a structured Working Group.
– A Working Group on transplantation can be considered a network opportunity for young clinicians and scientists, interested in this particular field of nephrology and related projects.The acronym DESCARTES (Developing Education Science and Care for Renal Transplantation in European States) best summarizes the activity and mission of the group.

DESCARTES has the ambition to contribute, through education and research, to the improvement of the care of renal patients and especially of patients living with a kidney transplant.

As per the ERA-EDTA regulations for Working groups, the vision and mission of DESCARTES are:
1. To develop educational activities related to renal transplantation
DESCARTES has established the following educational priorities to promote pre-emptive transplantation and to stimulate living donor transplantation. The rationale is threefold: improving pre-emptive transplantation from living donors is a crucial step that may contribute to prevent organ shortage, and improve transplant rates and patient outcomes. In addition, general nephrologists (target audience for the DESCARTES educational activities) are those who can direct their patients reaching terminal kidney failure to pre-emptive living donor transplantation.
DESCARTES in collaboration with European Renal Best Practice (ERBP) worked on guidelines for pre-emptive living donor transplantation.
2. To promote and develop both clinical and biological research in the field of kidney transplantation, with the aim to improve patient outcomes.
DESCARTES major plan is to set up clinical trials whose main characteristics are: 1) to focus on unambiguous, meaningful clinical endpoints; 2) to include estimates of cost and cost-effectiveness; 3) to set up trials with sufficiently long follow-up time; 4) to enrol patients that are usually excluded from industry-driven clinical trials; 5) to provide a network of clinical trial sites for future translational research projects.
3. To foster communication between members with related research interests, and to collaborate when possible with other ERA-EDTA Working Groups.
DESCARTES deliberately started collaborating with ESOT (European Society of Organ Transplantation) in order to join forces in terms of guidance (education) and science in the field of renal transplantation in Europe. DESCARTES is also planning to coordinate its activity in close relation to the already existing ERA-EDTA Working Groups and Bodies.

BOARD

Luuk Hilbrands (Netherlands) – Chair
Gabriel Oniscu (United Kingdom) – Vice Chair
Daniel Abramowicz (Belgium)
Marta Crespo (Spain)
Umberto Maggiore (Italy)
Christophe Mariat (France)
Geir Mjøen (Norway)
Licia Peruzzi (Italy)
Mehmet Surku Sever (Turkey)
Bruno Watschinger (Austria)

HOW TO JOIN THE WORKING GROUP

Being a ordinary member of the DESCARTES means being part of a network which facilitates exchanges of ideas on basic science research and new treatment protocols.

Becoming an ordinary member of the DESCARTES is FREE OF CHARGE (ERA-EDTA Membership is not mandatory) and is also open to non-nephrologists.

By joining the DESCARTES you will receive constant updates on the Working Group initiatives be included in the Directory of DESCARTES’ ordinary members and start networking with colleagues from all over the world.

Click here to join.

The ordinary membership application is subject to validation. Please allow some time for a quick administrative check before applying multiple times.

PUBLICATIONS

How should I manage immunosuppression in a kidney transplant patient with COVID-19? An ERA-EDTA DESCARTES expert opinion
Nephrology Dialysis Transplantation, June 2020

Pre-existing malignancies in renal transplant candidates—time to reconsider waiting times
Nephrology Dialysis Transplantation, August 2019

Standard work-up of the low-risk kidney transplant candidate: a European expert survey of the ERA-EDTA Developing Education Science and Care for Renal Transplantation in European States Working Group
Nephrology Dialysis Transplantation, September 2019
PRESS RELEASE – Fewer medical tests – timely listing for transplantation January 22, 2019

Diagnosis and management of asymptomatic bacteriuria in kidney transplant recipients: a survey of current practice in Europe
Nephrology Dialysis Transplantation, September 2018

Recent advances in kidney transplantation: a viewpoint from the Descartes advisory board
Nephrology Dialysis Transplantation, 12 January 2018
PRESS RELEASE: Descartes Advisory Board declares: New allocation rules have to be developed!
January 26, 2018

Long-term risks of kidney living donation: review and position paper by the ERA-EDTA DESCARTES working group
Nephrology Dialysis Transplantation, February 2017 – Informed consent: Information for the kidney live donor concerning the long term risk of donor nephrectomy
PRESS RELEASE: How “safe” is it to donate a kidney? / A position paper by the ERA-EDTA DESCARTES working group
February 17, 2017

Does pre-emptive transplantation versus post start of dialysis transplantation with a kidney from a living donor improve outcomes after transplantation? A systematic literature review and position statement by the Descartes Working Group and ERBP
Nephrology Dialysis Transplantation, May 2016

Strategies to increase the donor pool and access to kidney transplantation: an international perspective.
Nephrology Dialysis Transplantation, February 2015

Criteria For And Appropriateness Of Renal Transplantation In Elderly Patients With End-Stage Renal Disease: A Literature Review And Position Statement On Behalf Of The European Renal Association-European Dialysis And Transplant Association Descartes Working Group And European Renal Best Practice.
Transplantation, July 2016

Immunosuppression in the elderly renal allograft recipient: a systematic review
Transplant Rev (Orlando), May 2016

The DESCARTES-Nantes survey of kidney transplant recipients displaying clinical operational tolerance identifies 35 new tolerant patients and 34 almost tolerant patients.
Nephrology Dialysis Transplantation, January 2016

As a follow-up of the Descartes CME in Parma, November 20th, 2014, dedicated to “Renal Transplantation in the Elderly”, DESCARTES was invited to prepare an issue for the Journal Transplantation reviews (http://www.journals.elsevier.com/transplantation-reviews/, Editors: Stuart J. Knechtle, and Julio Pascual) related to various themes and lectures presented at the Parma meeting. The editors of this issue were Umberto Maggiore, Daniel Abramowicz, and Klemens Budde. The issue is available at http://www.transplantationreviews.com/issues?issue_key=S0955-470X(15)X0004-8

ONGOING PROJECTS

Does kidney transplantation improve survival in the current era in Europe? Analysis of several European registries project, submitted by DESCARTES, was selected to be one of the projects to be supported by the ERA-EDTA through the Long Term Fellowship Programme.

Randomized trial on failing grafts – the group is embarking on a RCT on the management of immunosuppression after graft failure. The trial shall focus on two main questions: 1. Can we prevent HLA sensitisation and/or explanation by continuing immunosuppression? 2. Is it safe to maintain immunosuppression after graft failure? Inclusion criteria: Inclusion of patients with a failing graft that re-start dialysis; Inclusion of candidates for re-Tx. Inclusion can proceed up to 3 months after graft failure in patients under CNI (in order to better identify those who are candidates for re-tx). Treatment comparisons: low-dose CNI + low dose steroids/steroid tapering vs low dose steroids/steroid tapering Outcome: Efficacy: calculated PRA after 1 year follow-up, graft nephrectomy, transplantation rate. Safety: death, infection, hospitalization. The failing renal graft an ERA-EDTA initiated randomized trial project, submitted by DESCARTES in collaboration with EUDIAL and IWG (it is planned to include immunological studies concerning memory B cells), was selected to be one of the projects to be supported by the ERA-EDTA in 2019. The Association is in fact grating one young member of the ERA-EDTA, Ms Consuelo De Biase, the possibility to be involved in the project by providing her a one year Long Term Fellowship.

European survey on the communication of long-term risks to potential living kidney donors – Living kidney donation is the best available treatment for end-stage renal disease. The evaluation of living donors is standardized and quite similar across Europe. However, there is no consensus about how to inform those who are considering living kidney donation about potential long-term risks. DESCARTES together with EKITA (ESOT) created a survey to prospect how transplant professionals from all over Europe disclose these risks to those who are considering living kidney donation. The results of this survey will help create a recommendation for how to inform potential living donors. The survey was dispatched to all DESCARTES members between June 2018 and March 2019. The survey closed and the group is currently finalizing a paper related to this topic.

Ethical challenges in living unrelated donor transplantation – Ethical challenges are very frequent in transplantation and prominent in living unrelated donor transplantation (LUDRTx). There are several types of donors in LURDTx practice; they are simply classified as; altruistic, emotionally related (or conventional) and definitely unrelated (or unconventional) donors. Ethical problems are minimal / negligible in the case of “conventional” donations, while significant in definitely unrelated donor (“unconventional”) transplantations, because donor reimbursement is considered. In the declaration of Istanbul Summit, which was held with representatives from >150 different countries in 2008, it was stated that “donors may be reimbursed for verifiable expenses”; this statement was endorsed by WHO again in 2008. This reimbursement has been the subject of extensive debates. DESCARTES is running a project, coordinated by M. Sukru Sever, with the aim of formulating a well-balanced European attitude on this highly debated practice. A first draft was shared with the ERA-EDTA Ethics Committee and is currently subject to adjustments.

‘Diagnosis and management of asymptomatic bacteriuria in adult kidney transplant recipients’ Survey. Aa survey was circulated to physicians taking care of adult kidney transplant recipients on a regular basis and working in Europe. The survey was aimed at identifying the current practice in Europe regarding diagnosis and management of asymptomatic bacteriuria (i.e., bacteriuria without symptoms or signs suggestive of urinary tract infection) after adult kidney transplantation. In collaboration with ESGICH Working Group (European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Infections in Compromised Hosts). Related publications: Diagnosis and management of asymptomatic bacteriuria in kidney transplant recipients: a survey of current practice in Europe

The Tomogram study (completed). The first publication from the ongoing DESCARTES study on operational tolerance was published (Massart et al.). The DESCARTES-Nantes survey of kidney transplant recipients displaying clinical operational tolerance identifies 35 new tolerant patients and 34 almost tolerant patients. Nephrol Dial Transplant 2016;31(6):1002-13.). The group launched a Europe-wide survey to assess the frequency of operational tolerance among kidney recipients. Operational Tolerance (opTOL) refers to a state of prolonged allograft survival in the absence of any immunosuppressive drugs or generalized immunodeficiency and is deemed to be extremely rare in kidney transplantation. 17 coordinators were recruited for 27 countries through the ERA-EDTA-DESCARTES working group. They sent a questionnaire to 256 transplant centres to identify tolerant or almost tolerant patients.

Work-up on the young (aged <=40yrs) uncomplicated transplant candidate. The DESCARTES WG proposed that in a subset of relatively young patients (<40 years) without significant comorbidities (such as diabetes or cardiovascular disease), the work-up for transplantation could be restricted to a small set of tests. Aiming for agreement between transplant centres across Europe, we surveyed the opinion of 80 transplant professionals from 11 European states on the composition of a minimal work-up. Based on the results of the survey, published guidelines and expert meetings by the DESCARTES Working Group, we have formulated a proposal for the work-up of low-risk kidney transplant candidates. Publication: Standard work-up of the low-risk kidney transplant candidate: a European expert survey of the ERA-EDTA Developing Education Science and Care for Renal Transplantation in European States Working Group , Umberto Maggiore et al.

Collaboration with the European Renal Best Practice (ERBP). ERBP and DESCARTES prepared guidelines concerning the evaluation and preparation of donor and recipient of a kidney transplant, in the pre-transplant and peri-operative period. Related publication: Does pre-emptive transplantation versus post start of dialysis transplantation with a kidney from a living donor improve outcomes after transplantation? A systematic literature review and position statement by the Descartes Working Group and ERBP

EVENTS

DESCARTES is the official organiser of the CTDay 2020 PATIENT MANAGEMENT AND EMPOWERMENT IN THE POST COVID-19 WORLD a fully virtual event that will be held on November 20, 2020.

Click here here to learn more about the event.

PAST EVENTS

One size does not fit all – Specific challenges posed by individual donor, recipient and transplant characteristics – CTDay – November 29, 2019 – Barcelona, Spain – click here to view the online available materials.

Making the right decision in kidney transplantation: current controversies on clinical and ethical issues – October 12, 2018 – Edinburgh, UK

How can I improve the outcomes of kidney transplantation in my center? – October 13, 2017 – Antwerp, Belgium – click here to view the online available materials.

Latest developments in transplantation medicine: selected topics you should know – November 4-5, 2016 – Berlin, Germany – click here to view the online available materials.

DESCARTES – Developing Education Science and Care for Renal Transplantation in European States

The ordinary membership application is subject to validation. Please allow some time for a quick administrative check before applying multiple times.

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