Priority 15 from the Kidney Transplant PSP

UNCERTAINTY: Does routine screening for and treatment of donor-specific antibodies improve outcomes?  What is the most effective treatment?
Overall ranking Priority questions agreed on but not put in ranked order
JLA question ID 0037/15
Explanatory note Not available for this PSP
Evidence

Existing Systematic Review: Mohan, S., Palanisamy, A., Tsapepas, D., Tanriover, B., Crew, R. J., Dube, G., Ratner, L. E., Cohen, D. J., Radhakrishnan, J.  Donor-specific antibodies adversely affect kidney allograft outcomes. Journal of the American Society of Nephrology. 2012;23(12):2061-71
Ongoing Randomised Controlled Trial: Eskandary, F., Bond, G., Schwaiger, E., Kikic, Z., Winzer, C., Wahrmann, M., Marinova, L., Haslacher, H., Regele, H., Oberbauer, R., et al. Bortezomib in late antibody-mediated kidney transplant rejection (BORTEJECT Study): study protocol for a randomized controlled trial. Trials. 2014;15(1):107 
Health Research Classification System category Renal and Urogenital
Extra information provided by this PSP
Original uncertainty examples

Does screening for de novo specific HLA antibody with intervention in positives (Rituximab plus increase in maintenance immunosuppression) cause more good than harm? Does DSA surveillance improve outcomes post-transplant? How can we treat patients who have antibodies against the kidney in their blood ? How can we best prevent antibodies damaging kidney transplants? Would affinity and binding kinetics measurement serve as risk stratification for cases with donor specific antibodies?

 
Comparison Diagnostics
Submitted by

Clinicians x 5
Outcomes to be measured Patient and graft survival, graft function, adverse events
PSP information
PSP unique ID 0037
PSP name Kidney Transplant
Total number of uncertainties identified by this PSP. 90  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 3 February 2016