Priority 19 from the Kidney Transplant PSP

UNCERTAINTY: Which treatments work best to prolong the life of the kidney transplant (for example different immunosuppression, blood pressure control)?
Overall ranking Priority questions agreed on but not put in ranked order
JLA question ID 0037/19
Explanatory note Not available for this PSP
Evidence

Existing Systematic Reviews: Birnbaum, L M., Lipman, M, Paraskevas, S, Chaudhury, P, Tchervenkov, J, Baran, D, Herrera-Gayol, A, Cantarovich, M Management of chronic allograft nephropathy: a systematic review. Clinical Journal of The American Society of Nephrology. 2009;4(4):860-5 ~
Lim, W. H., Eris, J., Kanellis, J., Pussell, B., Wiid, Z., Witcombe, D., Russ, G. R. A systematic review of conversion from calcineurin inhibitor to Mammalian target of rapamycin inhibitors for maintenance immunosuppression in kidney transplant recipients. American Journal of Transplantation. 2014;14(9):2106-19 ~
Su, L., Tam, N., Deng, R., Chen, P., Li, H., Wu, L. Everolimus-based calcineurin-inhibitor sparing regimens for kidney transplant recipients: a systematic review and meta-analysis. International Urology & Nephrology. 2014;46(10):2035-44 ~
Knight SR, Morris PJ. Steroid avoidance or withdrawal after renal transplantation increases the risk of acute rejection but decreases cardiovascular risk. A meta-analysis. Transplantation. 2010 Jan 15;89(1):1-14
Health Research Classification System category Renal and Urogenital
Extra information provided by this PSP
Original uncertainty examples

How can we treat/prevent CAN? what are the main causes of loss of function in a transplant? How can I prolong the life of my transplanted kidney What treatments slow progression of transplant dysfunction? Modulation of immunosuppression? BP control? How to prevent progressive loss of transplant function and return to dialysis How can we prevent late graft loss Can kidney transplants be helped to last the patient's entire lifetime? Can we prevent chronic graft dysfunction? What is the most effective way to prolong the life of my new kidney? Why do certain people have transplants which last for decades (30 + years) whilst the majority of others fail/reject after a much shorter period? There is a group of long standing patients who would be willing to take part in such research if it could be set up. What is being done to extend the life of the transplanted kidney. ? Why will a transplant not last the rest of my life? why is there little explanation of transplant failure ? Are there ways to avoid kidney failures

 
Comparison Surgery
Submitted by

Patient x 9 Clinicians x 17
Outcomes to be measured CAN, graft function, graft survival
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