Kidney Transplant Top 10
(in no order of priority):
- What is the best way to treat vascular or antibody-mediated acute rejection?
- How can immunosuppression be personalised to the individual patients to improve the results of transplantation?
- How can we prevent sensitisation in patients with a failing transplant, to improve their chances of another successful transplant (e.g. removal of the transplant, withdrawal of immunosuppressive medicines or continuation of these medicines?)
- Can we improve monitoring of the level of immunosuppression to achieve better balance between risk of rejection and side effects? (e.g. T-cell or B-cell ELISPOT, point-of-care tacrolimus monitoring, MMF monitoring)
- How can we improve transplant rates in highly sensitised patients?
- What are the long-term health risks to the living kidney donor?
- How can we encourage tolerance to the transplant to prevent or reduce the need for immunosuppression? (e.g. by use of T-regulatory cells, induction of haemoxygenase 1)
- What is the best combination of immunosuppressive drugs following kidney transplantation? (e.g. azathioprine or mycophenolate, belatacept, generic or proprietary (brand-name) drugs)
- What techniques to preserve, condition and transport the kidney before transplantation allow increased preservation times and/or improve results? (e.g. machine perfusion, normothermic reconditioning, addition of agents to the perfusate)
- Can bioengineered organs be developed to be as safe as human-to-human transplants? How can this be achieved?
The remaining questions discussed at the workshop were (in no order of priority):
- Which combinations of immunosuppressive drugs can minimise side effects in kidney transplant recipients (such as infections, diarrhoea, malignancy)?
- For which patients is transplantation not suitable (considering factors such as age, body mass index, history of cancer, co-morbidities)?
- How can we increase the number of potential living donors coming forward, and the proportion proceeding to donation?
- What is the best method of sharing deceased donor kidneys to ensure fair access to all age groups whilst minimising waiting times?
- Does routine screening for and treatment of donor-specific antibodies improve outcomes? What is the most effective treatment?
- How can we ensure fair and equal access to transplantation across the UK?
- What is the best way of educating patients about transplantation before their operation?
- For blood group incompatible transplants, which treatments most effectively reduce antibody levels and improve the safety and outcomes of the operation?
- Which treatments work best to prolong the life of the kidney transplant (for example different immunosuppression, blood pressure control)?
- How can we match organs to recipients to ensure the best overall outcomes (for example by age, nephron dosing)?
- How do we prevent the original cause of kidney failure returning (for example glomerulonephritis) following kidney transplant?
- What tests are required to determine whether a transplant is a suitable option for a patient?
- What approaches improve outcomes in adolescent and young adult kidney transplant recipients?
- Is there a reliable way for us to assess the suitability of individual organs for transplantation, and to predict outcomes?
To see more uncertainties identified for Kidney Transplant see the documents below