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Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
Published on: April 12, 2021
The KDIGO clinical practice guidelines for the care of kidney transplant recipients
1The Transplantation Society, Centre for Transplant and Renal Research, Millennium Institute, Westmead Hospital, University of Sydney, Westmead, NSW, Australia.
Insights
This clinical guideline provides recommendations for renal transplant recipient care, emphasizing immunosuppressed patients. It highlights areas where current evidence is limited, guiding future research and clinical practice.
Area of Science:
- Nephrology
- Immunology
- Clinical Medicine
Background:
- Clinical guidelines are essential for standardizing patient care.
- Renal transplantation requires specialized post-operative management, particularly concerning immunosuppression.
- Evidence-based practice necessitates a clear understanding of the strength of supporting data.
Purpose of the Study:
- To develop a clinical guideline for the care of renal transplant recipients.
- To focus on post-transplant management issues specific to immunosuppressed patients.
- To identify gaps in current clinical evidence for decision-making.
Main Methods:
- A comprehensive literature search identified 12,327 relevant articles, including randomized controlled trials, cohort studies, and reviews.
- A formal evaluation assessed the quality of data from A to D for each article.
- Statements were developed based on the strength of the evidence, defining levels of recommendation (Level 1: recommend, Level 2: suggest).
Main Results:
- The guideline addresses the care of renal transplant recipients, excluding pre-transplant evaluation.
- A significant portion (69%) of the recommendations are based on lower-quality evidence (Level C or D).
- The guideline explicitly identifies areas where clinical decision-making is not fully supported by robust data.
Conclusions:
- The guideline provides a framework for managing renal transplant recipients.
- It underscores the limitations of current evidence in many areas of post-transplant care.
- This work highlights the need for further research to strengthen clinical recommendations and improve patient outcomes.
Abstract:
The clinical guideline for care of renal transplant recipients was written by a committee of 15 people from nine countries, supported by an evidence review team The scope of the review was care of the patient after a renal transplant-not evaluation or selection of recipients and donors, focusing on the issue specific to the immunosuppressed transplant patient. A total of 12,327 articles comprising 3168 randomized controlled trials, 7543 cohort studies, and 1609 reviews were selected by a formal search. Each article was formally evaluated for the quality of the data from A to D. A consistent set of statements were based on the strength of the evidence. Level 1 evidence: "we recommend" means that if you were a patient, most people would want to do this; if a clinician, you should recommend this course of action to most patients; and if a policy maker, you should adopt this as a reasonable standard. Level 2 evidence: "we suggest" means the majority of patients would want do this; to the clinician, it means that different solutions may well be needed for different patients; whereas to the health policy maker, this is a strong warning to engage stakeholders in the creation of a particular local policy. Because 69% of the advice is "suggested" on the basis of level C or D evidence, one outcome of this work is to make it clear where the current evidence for clinical decisions runs out of data.
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01:16Kidney Transplant III: Nursing Management
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