pISSN 1226-6051
eISSN 2508-786X
eISSN 2508-786X
Key questions formulation using PICO format
| Key Question | Patient/Population | Intervention/Comparison | Outcomes | Healthcare Setting | Adaptable Guideline | |||
|---|---|---|---|---|---|---|---|---|
| Age | Gender | Risk | Comparator 1 | Comparator 2 | ||||
| Desensitization therapy | ||||||||
| What is the most effective desensitization therapy for ABO incompatibility or HLA sensitized kidney transplant patients? | Not assigned | Not assigned | Not assigned | Plasmapheresis and/or immunogl bulin and/or rituximab | Placebo/ other single or combination therapy | Acute rejection, graft survival, patient survival, infection (total) | Inpatient | BTS |
| Induction therapy | ||||||||
| Is an IL2-RA effective as an induction therapy for low-or medium immunologic risk kidney transplantation? | Not assigned | Not assigned | Low or medium | IL2-RAs | Placebo/ no treatment | Acute rejection, graft survival, patient survival, infection (total) | Inpatient | KDIGO, RA |
| Is lymphocyte-depleting antibodies, such as ATG, effective as induction therapy in high-risk patients? | Not assigned | Not assigned | High | ATG | IL2-RAs | Acute rejection, graft survival, patient survival, infection (total) | Inpatient | KDIGO, RA |
| Maintenance therapy | ||||||||
| Which CNI is the most safe and effective for maintenance immunosuppression aft r kidney transplantation? | Not assigned | Not assigned | Not assigned | Tacrolimus | Cyclosporine | Rejection, graft survival, patient survival, renal function, infection (total), malignancy | In/ outpatient | KDIGO, RA |
| Which antimetabolite is the most safe and effective for maintenance immunosuppression after qkidney transplantation? | Not assigned | Not assigned | Not assigned | Mycophenolate | Azathioprine or mizoribine | Rejection, graft survival, patient survival, renal function, infection (total), malignancy | In/ outpatient | KDIGO, RA |
| Is mTOR inhibitors effective to use early after transplantation than CNI? | Not assigned | Not assigned | Not assigned | mTOR inhibitors (sirolimus or evorolimus) | CNIs (cyclosporine or tacrolimus) | Rejection, graft survival, patient survival, renal function, infection (total), malignancy | In/ outpatient | KDIGO, RA |
| Rejection therapy | ||||||||
| Should biopsy proven borderline change be treated? | Not assigned | Not assigned | Not assigned | Corticosteroids | Placebo/no treatment | Rejection, graft survival, patient survival, renal function, infection (total) | Inpatient | KDIGO, RA |
| What is the optimal treatment for T-cell mediated acute rejection? | Not assigned | Not assigned | Not assigned | Corticosteroids | ATG | Graft survival, patient survival, renal function, infection (total) | Inpatient | KDIGO, RA |
| Which treatment is the most effective and safe for antibody mediated acute rejection? | Not assigned | Not assigned | Not assigned | Plasma exchange and/ or immunoglobulin and/or bortezomib and/or rituximab | no treatment and/or steroid pulse and/or other single or combination therapy | Graft survival, patient survival, renal function, infection (total) | Inpatient | KDIGO, RA |
ATG, antithymocyte globulin; BTS, British Transplantation Society; CNI, calcineurin inhibitor; HLA, human leukocyte antigen; IL2-RA, interleukin-2 receptor antagonist; KDIGO, Kidney Disease: Improving Global Outcomes; mTOR, mammalian target of rapamycin; RA, Renal Association