73

In 2023, significant advances were made in various aspects of kidney transplantation. First, use of a balanced crystalloid solution in the recipient appears to help prevent delayed graft function, unlike donor hypothermia and normothermic machine perfusion. There have also been advances in understanding of the pathophysiology of humoral rejection, highlighting the major role of HLA class II molecules and innate immune cells (NK and monocytes expressing FCGR3A). An automatic Banff classification algorithm has been developed to better categorize biopsies in currently known diagnoses. CXCL10, combined with other variables of interest, appears to be an effective marker for ruling out rejection, but its role in routine care is yet to be defined. Regarding cytomegalovirus (CMV), letermovir has been proven to be effective in preventing CMV in D+R- patients, with fewer hematological side effects. For R+ patients, monitoring CMV-specific T cell immunity has been proposed to reduce the duration of antiviral prophylaxis. The sole innovation in immunosuppression has been the use of imlifidase for highly sensitized patients, guided by French recommendations. A new equation for measuring glomerular filtration rate has been developed for kidney transplant recipients, performing well across various analyzed stratifications. Finally, xenotransplantation has been back in the spotlight this year, generating a great deal of hope. However, the description of early humoral rejections involving innate immune cells indicates that adjustments are still needed before its widespread use can be envisaged.