pISSN 1226-6051
eISSN 2508-786X
eISSN 2508-786X
Results of the survey to select clinical questions of recommendations on immunosuppressive therapies
| Questions | Survey 1 | Survey 2 | |
|---|---|---|---|
| Importance (%) | Agreement (%) | ||
| Induction therapy | |||
| I-1 | Is it effective to use immunosuppressants before the kidney transplantation? | 86.4 | 72.7 |
| I-2 | Is biological agents effective for induction therapy? | 78.8 | 36.4 |
| I-3 | In patients at low or moderate immunological risk, is IL2-RA effective? | 75.6 | 100 |
| I-4 | In patients at high immunological risk, is lymphocyte depleting antibodies effective? | 72.0 | 100 |
| Maintenance therapy (initial) | |||
| M-1 | Is combination treatment of immunosuppressants as maintenance therapy effective to prevent the rejection after transplantation? | 84.0 | 100 |
| M-2 | Which CNI is safe and effective for the first-line maintenance therapy? | 80.0 | 100 |
| M-3 | Should CNI treatment be initiated before transplantation? | 73.6 | 18.2 |
| M-4 | Who needs to change from immediate release formulated tacrolimus to slow release formulation for maintenance therapy? | 68.8 | 36.4 |
| M-5 | Is it effective to change from TAC to CSA or mTOR inhibitors, if the patients suffer intolerable or adverse reactions to tacrolimus? | 75.2 | 36.4 |
| M-6 | Which antimetabolites is the first-line as maintenance therapy? | 79.6 | 36.4 |
| M-7 | Is mycophenolates more effective and safe than azathioprine or mizoribine as an initial maintenance therapy? | - | 100 |
| M-8 | Does MMF provide equivalent efficacy and tolerability with MPS? | 74.4 | 36.4 |
| M-9 | Is it safe to discontinue steroids early for patients with low immunological risk? | 58.4 | - |
| M-10 | Is it safe to use mTOR inhibitors in early transplantation period? | 72.4 | 18.2 |
| Maintenance therapy (long-term) | |||
| M-11 | What is the most effective and safe regimen for long term maintenance therapy? | 67.6 | 45.5 |
| M-12 | Is it effective and safe to continue CNI-based immunosuppressive therapy? | 77.2 | 45.5 |
| M-13 | Is it safe to continue at low dose if steroids are not withdrawn? | 73.2 | 72.7 |
| M-14 | Is it the most efficient method to measure blood levels of CNIs for monitoring immunosuppressive effects? | 82.8 | 54.5 |
| M-15 | What is the most appropriate parameter to monitor the effects of CSA? | 69.0 | 45.5 |
| M-16 | What is the most appropriate parameter to monitor the effects of TAC? | 74.4 | 45.5 |
| M-17 | When is the best time for taking blood sample to monitor the levels of CNIs? | 66.0 | 45.5 |
| M-18 | Should therapeutic levels of mycophenolates be monitored? | 56.4 | - |
| M-19 | Should therapeutics levels of mTOR inhibitors be monitored? | 71.2 | 27.3 |
| Rejection therapy | |||
| R-1 | Should biopsy-proven borderline change be treated? | 72.0 | 100 |
| R-2 | What is the first-line therapy to treat acute rejection? | 85.2 | 72.7 |
| R-3 | What is the most appropriate corticosteroids regimen to treat T-cell mediated acute rejection? | - | 100 |
| R-4 | Is it effective to continue steroids after acute rejection treatment? | 74.0 | 36.4 |
| R-5 | Is it effective to treat with lymphocyte depleting agents for refractory or relapsed acute cellular rejection after corticosteroids treatment? | 70.8 | 18.2 |
| R-6 | Which treatments is the most effective for antibody mediated acute rejection? | 83.2 | 100 |
| R-7 | Which treatment is the most effective for acute rejection on antibody incompatible transplantation? | 71.6 | 63.6 |
| R-8 | Which is the most effective and safe antimetabolites after treating acute rejection? | 64.4 | 18.2 |
| Desensitization therapy | |||
| D-1 | Which treatment is the most effective as desensitization therapy for ABO incompatibility or HLA sensitized kidney transplantation? | - | 100 |
CNI, calcineurin inhibitors; CSA, cyclosporine; HLA, human leukocyte antigen; IL2-RA, interleukin-2 receptor antagonists; MMF, mycophenolate mofetil; MPS, mycophenolate sodium; mTOR, mammalian target of rapamycin; TAC, tacrolimus