Priority 2 from the Kidney Transplant PSP

UNCERTAINTY: In kidney transplant patients, how can immunosuppression be personalised to the individual patients to improve the results of transplantation?
Overall ranking Priority questions agreed on but not put in ranked order
JLA question ID 0037/2
Explanatory note Not available for this PSP

Ongoing Randomised Controlled  Trials - Sommerer, C., Schaier, M., Morath, C., Schwenger, V., Rauch, G., Giese, T., Zeier, M.  The Calcineurin Inhibitor-Sparing (CIS) Trial - individualised calcineurin-inhibitor treatment by immunomonitoring in renal allograft recipients: protocol for a randomised controlled trial.  Trials. 2014;15:489 ~
A multicenter, randomized, open-labeled study to steer immunosuppressive and antiviral therapy by measurement of virus (CMV, ADV, HSV)-specific T cells in addition to determination of trough levels of immunosuppressants in pediatric kidney allograft recipients (IVIST01-trial): study protocol for a randomized controlled trial.  EudraCT No: 2009-012436-32, ISRCTN89806912

Health Research Classification System category Renal and Urogenital
Extra information provided by this PSP
Original uncertainty examples

How should decisions regarding personalisation of immunosuppression to maximize graft and recipient survival be informed? Post transplant: Possible complications?  Additional procedures required? i.e. stent removal, dialysis access removal etc?  Reasons why different immunosuppressants are selected for different patients? Would it be possible to have individualized protocols post transplant rather then one rule for all? how can we determine how much immunosuppression is right There are more young patients surviving. They have to face multiple transplants, dialysis and taking  anti rejection medication for very long periods of time.  How can we protect these patients from the long term use of these drugs? What is the most effective immunosuppression for children post transplantation? Which immunosuppressive regimen provides the best survival and quality of life in elderly transplant recipients?

Comparison Drug
Submitted by Patients x 3, Clinicians x 4
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