Priority 18 from the Kidney Transplant PSP

UNCERTAINTY: For blood group incompatible transplants, which treatments most effectively reduce antibody levels and improve the safety and outcomes of the operation?
Overall ranking Priority questions agreed on but not put in ranked order
JLA question ID 0037/18
Explanatory note Not available for this PSP
Evidence

Existing Systematic Review: Macklin, P. S., Morris, P. J., Knight, S. R. A systematic review of the use of rituximab for desensitization in renal transplantation. Transplantation. 2014;98(8):794-805
Existing Randomised Controlled Trials: Eskandary, F., Wahrmann, M., Biesenbach, P., Sandurkov, C., Konig, F., Schwaiger, E., Perkmann, T., Kunig, S., Derfler, K., Zlabinger, G. J., et al. ABO antibody and complement depletion by immunoadsorption combined with membrane filtration - A randomized, controlled, cross-over trial. Nephrology Dialysis Transplantation. 2014;29(3):706-14 ~
Vo, A. A., Choi, J., Cisneros, K., Reinsmoen, N., Haas, M., Ge, S., Toyoda, M., Kahwaji, J., Peng, A., Villicana, R., et al. Benefits of Rituximab Combined With Intravenous Immunoglobulin for Desensitization in Kidney Transplant Recipients. Transplantation. 2014;98(3):312-319
Health Research Classification System category Renal and Urogenital
Extra information provided by this PSP
Original uncertainty examples

Will ABOi transplants become easier and more accessible? What is being done into antibodies Antibody incompatible transplantation is a growing treatment modality for hard to transplant cases. Should more be done to research novel strategies to deplete ABO/HLA antibodies prior to transplantation?

 
Comparison Drug
Submitted by

Patient x 1 Clinicians x 2
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