The KDIGO review of the care of renal transplant recipient.
This review highlights the key messages from the KDIGO (Kidney Disease: Improving Global Outcomes) clinical practice guidelines for care of kidney transplant recipients, which were written to be global guidelines irrespective of the regulatory, fiscal, cultural, socioeconomic, or geographical environment. The distillation of 3168 randomized control trials, 7543 cohort studies, and 1609 reviews led to recommendations rated by the strength of supporting evidence and the quality of the data from A to D. Despite this, the quality of the evidence is surprisingly low for the majority of decisions that are routinely taken in all transplant units throughout the world, highlighting the needs for properly designed randomized controlled trials. The principle areas covered in the guidelines include immunosuppression, management of acute rejection, monitoring of the patient and graft, chronic allograft injury, kidney biopsy, nonadherence, vaccination, infectious diseases, cardiovascular risk management, malignancy, bone disease, pediatric growth, lifestyle, fertility, and mental health. This review highlights a number of these areas for consideration focusing on the different types of evidence that we use in daily clinical practice.
Tai
Edward
E
Centre for Transplant and Renal Research, Westmead Millennium Institute, University of Sydney, Westmead Hospital, Westmead, Australia.
Chapman
Jeremy R
JR
D050723:Fractures, Bone / Q000209:etiology / Q000517:prevention & control; D005921:Glomerulonephritis / Q000209:etiology / Q000517:prevention & control; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods / Q000592:standards; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods* / Q000592:standards*; D008019:Life Style; D009369:Neoplasms / Q000209:etiology / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D012008:Recurrence; D016896:Treatment Outcome; D014777:Virus Diseases / Q000209:etiology / Q000517:prevention & control