KidneyCare Guided Immuno-Optimization in Renal Allografts: The KIRA Protocol
Abstract
:1. Introduction
2. The KidneyCare Platform-Three-Pronged, Multimodality Testing
2.1. AlloSure®-Donor-Derived-cfDNA (dd-cfDNA)
2.2. AlloMap Kidney®-Gene Expression Profiling (GEP)
2.3. iBox-Allograft Prognostic Score
3. Methods
Abnormal Biopsy Result
4. Results/Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Post-Tx Regimen | Week 1 | Mon 1 | Mon 2 | Mon 3 | Mon 4 | Mon 5 | Mon 6 | Mon 7 | Mon 8 | Mon 9 | Mon 10 | Mon 11 | Mon 12 |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Prednisone | Center protocol | 5 mg | 5 mg | 5 mg | 5 mg | 5 mg | 5 mg | 5 mg | 5 mg | 5 mg | 5 mg | 5 mg | 5 mg |
MMF q 12 h | 1000 mg | 1000 mg | 1000 mg | 1000 mg | 750 mg | 750 mg | 500 mg | 500 mg | 500 mg | 250 mg | 250 mg | 0 mg | 0 mg |
Tacrolimus goal (ng/mL) | 8–12 | 8–12 | 8–12 | 8–12 | 8–12 | 8–12 | 8–12 | 6–8 | 6–8 | 6–8 | 6–8 | 6–8 | 6–8 |
DSA | X | X | X | X | X | ||||||||
BK screening | X | X | X | X | X | X | X | X | X | X | X | X | |
KidneyCare | X | X | X | X | X | X | X | X | X | X | X | X | X |
Protocol Bx | X | X |
Post Tx Regimen | 13 Month | 14 | 15 | 16 | 17 | 18 | 19 | 20 | 21 | 22 | 23 | 24 |
---|---|---|---|---|---|---|---|---|---|---|---|---|
DSA | X | X | X | X | ||||||||
BK screening | X | X | X | X | X | X | X | X | X | X | X | X |
KidneyCare | X | X | X | X | X | X | X | X | X | X | X | X |
Cystatin C | X | X | ||||||||||
Protocol Bx | X |
Post Tx Regimen | Week 1 | Mon 1 | Mon 2 | Mon 3 | Mon 4 | Mon 5 | Mon 6 | Mon 7 | Mon 8 | Mon 9 | Mon 10 | Mon 11 | Mon 12 |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Prednisone | 30 mg | 10 mg | 5 mg | 5 mg | 0 mg | 0 mg | 0 mg | 0 mg | 0 mg | 0 mg | 0 mg | 0 mg | 0 mg |
MMF q 12 h | 1000 mg | 1000 mg | 1000 mg | 1000 mg | 750 mg | 750 mg | 500 mg | 500 mg | 500 mg | 500 mg | 500 mg | 500 mg | 500 mg |
Tacrolimus goal (ng/mL) | 8–12 | 8–12 | 8–12 | 8–11 | 8–12 | 8–12 | 8–12 | 8–12 | 8–12 | 6–8 | 6–8 | 6–8 | 6–8 |
DSA | X | X | X | X | X | ||||||||
BK screening | X | X | X | X | X | X | X | X | X | X | X | X | |
Kidney Care | X | X | X | X | X | X | X | X | X | X | X | X | X |
Protocol Bx | X | X |
Post Tx Regimen | 13 Month | 14 | 15 | 16 | 17 | 18 | 19 | 20 | 21 | 22 | 23 | 24 |
---|---|---|---|---|---|---|---|---|---|---|---|---|
DSA | X | X | X | X | ||||||||
BK screening | X | X | X | X | X | X | X | X | X | X | X | X |
KidneyCare | X | X | X | X | X | X | X | X | X | X | X | X |
Cystatin C | X | X | ||||||||||
Protocol Bx | X |
New DSA | AlloSure (%) | 3 yr iBox Score | AlloMap Kidney (RUO) | Action |
---|---|---|---|---|
Negative | ≤0.2 | > 85% | <10 | Proceed/Minimize |
Negative | >0.2 ≤ 0.5 | >85% | <10 | Proceed/Minimize |
Negative | >0.5 + ≤ 61% change | >85% | <10 | Proceed/Minimize |
Positive | >0.2 ≤ 0.5 | <85% | Any value | Repeat |
Negative | >0.5 + >61% change | >85% | Any value | Repeat |
Positive | >0.5 + ≤61% change | <85% | Any value | Not Safe to Proceed |
Positive | >0.5 + >61% change | <85% | Any value | Not Safe to Proceed |
Positive | ≤0.2 | <85% | >10 | Not Safe to proceed |
Positive | >1 | <85% | Any value | Not Safe to Proceed |
Negative | >1 | >85% | Any value | Not Safe to Proceed |
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Share and Cite
Gray, J.N.; Wolf-Doty, T.; Sulejmani, N.; Gaber, O.; Axelrod, D.; Abdalla, B.; Danovitch, G. KidneyCare Guided Immuno-Optimization in Renal Allografts: The KIRA Protocol. Methods Protoc. 2020, 3, 68. https://doi.org/10.3390/mps3040068
Gray JN, Wolf-Doty T, Sulejmani N, Gaber O, Axelrod D, Abdalla B, Danovitch G. KidneyCare Guided Immuno-Optimization in Renal Allografts: The KIRA Protocol. Methods and Protocols. 2020; 3(4):68. https://doi.org/10.3390/mps3040068
Chicago/Turabian StyleGray, Jennifer N., Theresa Wolf-Doty, Nimisha Sulejmani, Osama Gaber, David Axelrod, Basmah Abdalla, and Gabriel Danovitch. 2020. "KidneyCare Guided Immuno-Optimization in Renal Allografts: The KIRA Protocol" Methods and Protocols 3, no. 4: 68. https://doi.org/10.3390/mps3040068