KDIGO CLINICAL PRACTICE GUIDELINE ON THE EVALUATION … · 14508 All Txp First KTxp, on HD or PD before Txp nd nd 48 (14) 61 nd 27 nd nd nd nd nd nd nd nd 27 reported as comorbidity

KDIGO CLINICAL PRACTICE GUIDELINE ON THE EVALUATION AND MANAGEMENT OF CANDIDATES

FOR KIDNEY TRANSPLANTATION

SUMMARY TABLES & EVIDENCE PROFILES

KDIGO-TransplantCandidateGuidelineTopic:RegistrystudiesCategoricaloutcomes

Pubmedid Authors Year Nameofdatabase Country Periodofpatientrecruitment

Lengthoffollow-up(mean/median)

Nanalyzed Eligibilitycriteria:General

Eligibilitycriteria:CKDspecific

Eligibilitycriteria:Agespecific

Eligibilitycriteria:Others Age,mean(SD)/median(range),years Sex,male,% Race,White,%

Race,Black,%

Race,Asian(total),%

Race,EastAsian,%

Race,SouthAsian,%

Race,MiddleEasten,%

Race,Hispanic,%

Race,Other,% Primarykidneydisease,GN,%

Primarykidneydisease,HTN,%

Primarykidneydisease,DM,%

Primarykidneydisease,Other,%

Dialysisduration

Dialysismodality

Repeatorh/oKTxp,%

Panelreactiveantibody,%ormean(SD)

PREDICTORSOFMORTALITY23295317 Cannon 2012 UNOS US 2004-2009 nd 74983 AllTxp Kidney-alonetransplant nd BMI10-60 48(16) 60 55 24 5 nd nd nd 14 nd,2% nd 21 16 nd nd nd nd 16.0%(29.1)

24138318 Farrugia 2014 HES/ONS UK 2001-2012 4.4years 19103 AllTxp KTxpalone nd excludedcaseswithincomplete

demographicinfo

median(IQR)45(34,55) 61 72 5 9 nd nd nd nd mixed1%,

othernot

reported11%

nd nd 16%reportedas

comorbidity

nd nd nd nd nd

20814353 Huang 2010 OPTN/UNOS US 2000-2008 atleast2

years

31179 AllTxp nd >-60yo nd median(IQR):60-69yo64(61,66),70-79yo

72(71,74),>=80yo81(80,82)

63 63 20 nd nd nd nd 10 nd 11 26 12 othernot

reported51%

preemptive

17%,>3y

32%

nd nd peakPRA>20%:

4%

26660200 Ilori 2015 OPTN/UNOS US 1996-2010 nd 44013 AllTxp nd >=60years nd median(IQR)65(7.0) 63 62 20 5 nd nd nd 11 nd,2% 15 25 34 cystickidney

disease9%,other

unknown17%

median

(IQR)2.47

years(2.81)

nd nd nd

24009216 Kainz 2013 OEDTR Austria 1992-2011 median7.41

years

553 AllTxp FirstKTxp nd Underwentecho1yearbeforeKTxp(allpt

whowerepotentiallyeligibleforrenal

allograftwait-listingunderwentabaseline

echowithannualf/uwhilebeinglisted)

52(13) 58 100(based

onstudy

conductedin

Austria)

0 0 0 0 0 0 0 23 nd 14 vascular9%,

otherunknown

55%

median

(IQR),

LA2D<=53m

m1.9yr

(0.8,3.2),

LA2D>53mm

1.8(0.9,3.2)

nd 0 median(IQR),

LA2D<=53mm

0%(0,0),

LA2D>53mm

0%(0,4)

27336396 Kang 2016 UNOS US 2005-2013 3.9years 104632 AllTxp KTxpalone,notforeigndonor

kidneyrecipients

>=18yo excludedrecipientswithapretransplant

cancerotherthanskincancerwithout

coexistingskingcancer

median(IQR):w/opre-Txpskincancer53

(42,61),w/pre-Txpskincancer64(57,70)

61 50 27 6 nd nd nd 15 nd nd nd 34%reportedas

comorbidity

nd nd nd 0 nd

26147285 Krishnan 2015 RR/NHSBT UK 2004-2010 nd 8082 AllTxp FirstKTxp nd nd >70yo:2%,50-70:41% 63 85 4 9 nd nd nd nd nd,2% 21 6 8 pyelonephritis

10%,polycystic

disease16%,

uncertain36%

nd nd 0 nd

26720436 Lynch 2016 USRDS US 2000-2010 nd 37623 AllTxp nd medicare

population

includedonlyptwithcontinuousprimary

coveragethroughmedicareforatleast1

yearbeforeandafterTxp

48.6(13.6) 60 58 34 nd nd nd nd 16 othernot

reported8%

21 23 31 Cystic/hereditary

/congenital8%,

Neoplasms/tumo

rs2%,other15%

5.7years

(4.5)

nd priororgan

Txp17%

nd







Race,Black,%

Race,Asian(total),%

Race,EastAsian,%

Race,SouthAsian,%

Race,MiddleEasten,%

Race,Hispanic,%





Dialysisduration

Dialysismodality

Repeatorh/oKTxp,%


21449945,27391198,22156753 Molnar 2011,2015,2016SRTR,DaVita US 2001-2007 median:717

days,IQR

(356,1206)

14508 AllTxp FirstKTxp,onHDorPD

beforeTxp

nd nd 48(14) 61 nd 27 nd nd nd nd nd nd nd nd 27reportedas

comorbidity

nd 0-6m12%,

6-24m29%,

2-5y36%,

>5y23%

HD86%,PD

14%

0 10.1%(24.0)

8961 AllTxp FirstKTxp,onHDbeforeTxp nd Excludedptswithoutelectronically

recordedserumalbuminlevelsinthelast

quarterpriortotransplantation,lacked

datafromthebaselinequarter,with

outliervaluesforage

.

10083 AllTxp FirstKTxp,onHDbeforeTxp >=18yo nd

26102616 Opelz 2016 CTS Germany 1995-2012 10years 46548 AllTxp FirstKTxp >=18years Noh/ocombinedorganTxp,smoking

statuswasdocumentedatthetimeofTxp

>60yo:18% 62 73 nd nd nd nd nd nd nd,30% nd nd nd nd nd nd 0 nd

24070588 Pieloch 2014 UNOS US 2001-2006 3years 30132 AllTxp FirstTxp adults excludedptwithmultiorganTxp 48.4(13.9) 57 56 22 nd nd nd nd 13 unknown8% nd nd nd nd nd 82 0 nd

25758804 Pieloch 2015 OPTN/UNOS US 2000-2008 3years 100261 AllTxp nd adults excludedptwithmultiorganTxp 18-4949%,50-6438%,>=6513% nd nd nd nd nd nd nd nd nd nd nd 29%reportedas

comorbidity

nd 0years10%,

0-455%,4

24%

nd nd nd

21566110 Reddy 2011 OPTN/UNOS US 2001-2007 3years 75681 AllTxp FirstTxp >18yo excludedmultiorganTxp,ptwithpre-Txp

HCVinfection,includedptwithatleast

onefollow-upvisitreportedto

OPTN/UNOS

>=60yo26% 60 56 23 5 nd nd nd 13 unknown2.2% 20 23.4 25 unknown21% no19%,<1

year18%,1-

3years31%,

>=3years

33%

nd 0 >=10%18%

21415312 Streja 2011 SRTR/MHD US 2001-2007 2.3years 10090 AllTxp FirstTxp nd nd 49(13) 51 nd 27 4 nd nd nd 15 nd nd nd 45%as

comorbidity

nd <6m12%,6-

24m29%,2-

5y37%,>

5y23%

nd 0 10.3(24.0)

25135680 Wightman 2014 UNOS US 2008-2011 nd 2076 AllTxp FirstTxp,excludedmulti-

organTxp

children nd <5y10%,5-12y31%,13-18y59% 57 50 19 3 nd nd nd 27 American

Indian/Alaska

Native0.7%,

native

Havaiian/Othe

r0.4%,

multiracial1%

15 0 0 structural37%,

FSGS15%,other

notreported

34%,missing

1.4%

nd 0 nd







Race,Black,%

Race,Asian(total),%

Race,EastAsian,%

Race,SouthAsian,%

Race,MiddleEasten,%

Race,Hispanic,%





Dialysisduration

Dialysismodality

Repeatorh/oKTxp,%


25098499 Xia 2014 SRTR/OPTN US 2000-2013 3years 486 AllTxp KidneyaloneTxp,deceased

donor

adults ExcludedHBVsAg+,hadmissingor

unknownHIVorHCVserostatusor

receivedapreviouslivertransplant

50.7(11.4) 72 nd 62 nd nd nd nd nd nd nd nd 21 nd >3years

72%

nd 8 >30%,30%

26636735 Barraclough 2016 ANZDATA Australia,NewZealand 2000-2012 nd 7826 AllTxp Kidneytxpalone,recipients

ofmulitpleorgantransplants

wereexcluded

adults Recipientsofmulitpleorgantransplants

wereexcluded

18-44:38.6%

46-64:52.6%

65+:8.8%

62.8 nd nd nd nd nd nd nd indigenous

Australian:

3.5%

nonindigenous

Australian:

96.5%

nd nd 14 nd nd nd 2+graft

number:8.0%

0-9%:72.3%

10-49%:17.2%

≥50%:10.1%

28010785 Lim 2017 ANZDATA Australia,NewZealand 1994-2012 median6.5

years

10,714 Alltxp Allprimarylivingand

deceaseddonorkidney

transplantrecipients

nd recipientsofmultiple-organtransplants,

recipientsofkidneytransplantswhohad

receivedtwoormoregraftsbetween1994

and2012,recipientswithtypeIdiabetes,

andthosewithoutdocumenteddiabetes

statuswereincluded

49.2 62.1 80.6 nd nd nd nd nd nd indigenous:

8.2%

other:11.2%

44.2 4.5 9.2 42.1 nd nd nd nd

28361229 Ladhani 2017 ANZDATA Australia,NewZealand 1994-2013 median8.4

years

750 Children

receiving

firsttxp

Kidneytxp 2-18years registryisacomprehensivedatabaseofall

childrenandadultswhohaverecevied

renalreplaccementtherapysince1965in

AustraliaandNewZealand

2-6:23.6%

7-10:20.9%

11-15:28.8%

16+:26.7%

58.3 79.6 nd nd nd nd nd nd indigenous:

8.3%

other:16.7%

30.8 nd nd 69.2 nd nd 0 0-25:87.2

26-50:4.1

51-75:4.3

76-100:2.9

26924061 Pruthi 2016 UKRR(UKRenalRegistry) UK 1997-2009 nd(through

December

2012)

4750 Incident

renal

transplant

patientsin

theUK,aged

>16years

witha

primary

renal

diagnosisof

GNorAPKD

Incidentrenaltransplant

patientswithprimaryrenal

diagnosisofGNorAPKD

>16years nd GNgroup:median45

ADPKDgroup:median53

62 89 4 5 nd nd nd nd 2 62.6 nd nd ADPKD:37.4 GNgroup:

median1.9

years

ADPKD

group:

median1.6

years

nd nd nd







Race,Black,%

Race,Asian(total),%

Race,EastAsian,%

Race,SouthAsian,%

Race,MiddleEasten,%

Race,Hispanic,%





Dialysisduration

Dialysismodality

Repeatorh/oKTxp,%


PREDICTORSOFGRAFTLOSS24370342 Tancredi 2014 OPTN US 2000-2010 1year(for

graftfailure)

6032 AllTxp FirstKTxp <18years Noh/ocombinedorganTxp;hada

functioninggraftonpostopday1;

albumin,HLAmismatchlevel,h/odialysis

available

10.9(5.2) 59 53 19 nd nd nd nd 23 nd nd nd nd congenital/

structuralcauses

in47%,FSGSin

14%,other

glomerular

diseasesin26%,

malignanciesin

1%,othercauses

in7%,and

unknowncausein

5%

nd HD34%,PD

34%,no

dialysis31%

0 nd

12110738 Briganti 2002 ANZDATA Australia,NewZealand 1988-1997 10y 1505 biopsy-

provenGN

firstKTxp nd nd median46,IQR36-57 68 nd nd nd nd nd nd nd nd 100 0 0 0 median15,

IQR8-20

nd 0 median6,IQR

(0-45)

23295317 Cannon 2012 UNOS US 2004-2009 nd 74983 AllTxp Kidney-alonetransplant nd BMI10-60 48(16) 60 55 24 5 nd nd nd 14 nd,2% nd 21 16 nd nd nd nd 16.0%(29.1)

21797974

Clayton 2011 ANZDATA Australia,NewZealand 1988-2007 median6.7y 1521 biopsy-

provenIgAN

>=16years primary

kidney-only

txp

nd 43(11.9) 76 80 nd nd nd nd nd nd 20 0 0 0 IgAN100% 0-<6months

0%,6

months-<1

year17%,1

to<5years

49%,>=5

years14%

nd 0 <=50%92%,

>50%7%

22124283 Foster 2011 USRDS US 1988-2009 median5.9y 90689 firstKtxp <40y nd nd 0-4y2.6%,5-9y2.8%,10-12y2.4%,13-16y

5.5%,17-20y,7.0%,21-24y9.3%,25-29y

17.9%,30-34y24.1%,35-39y28.5%

57.8 69.2 23.5 nd nd nd nd nd 7.3 28.3 nd nd CAKUT8.2%,

FSGS8.3%,

unknown22.9%,

other32.3%

median13.8

months

(IQR:4.2-

31.0)

nd 0 nd







Race,Black,%

Race,Asian(total),%

Race,EastAsian,%

Race,SouthAsian,%

Race,MiddleEasten,%

Race,Hispanic,%





Dialysisduration

Dialysismodality

Repeatorh/oKTxp,%


23406350 Heaphy 2013 SRTR US 1995-2010 nd 109392 deceased-

donorktxp

firstTxpofanyorgan >18y exclusions:coldischemiatimeslessthan1

h(n=156)orgreaterthan60h(n=378);

donorslistedaslessthan1yearorgreater

than80yearsofage(n=602);recipients

withacreatininelevelgreaterthanthe

99thpercentileofthesampleequivalent

toavalueof4.0(n=1340);missingdonor

height(n=323),donorweight(n=3)and

donorcreatinine(n=618);donorswitha

BMIlessthan13orgreaterthan50(n=

3403);andmultiorgantransplants(n=

3265)

median52,IQR42-61 60.7 48.4 31.7 5.3 nd nd nd 12.8 multiracial

0.2%,

american

indian/alaskan

native1.1%,

hawaiian/othe

rpacific

islander0.5%

nd nd nd nd nd nd 0 median0,IQR

0-0{073.1%,1-

3015.9%,31-

805.3%,>=81

2.4%}

20814353 Huang 2010 OPTN/UNOS US 2000-2008 atleast2

years

31179 AllTxp nd >-60yo nd median(IQR):60-69yo64(61,66),70-79yo

72(71,74),>=80yo81(80,82)

63 63 20 nd nd nd nd 10 nd 11 26 12 othernot

reported51%

preemptive

17%,>3y

32%

nd nd peakPRA>20%:

4%

26660200 Ilori 2015 OPTN/UNOS US 1996-2010 nd 44013 AllTxp nd >=60years nd median(IQR)65(7.0) 63 62 20 5 nd nd nd 11 nd,2% 15 25 34 cystickidney

disease9%,other

unknown17%

median

(IQR)2.47

years(2.81)

nd nd nd

24009216 Kainz 2013 OEDTR Austria 1992-2011 median7.41

years

553 AllTxp FirstKTxp nd Underwentecho1yearbeforeKTxp(allpt

whowerepotentiallyeligibleforrenal

allograftwait-listingunderwentabaseline

echowithannualf/uwhilebeinglisted)

52(13) 58 100(based

onstudy

conductedin

Austria)

0 0 0 0 0 0 0 23 nd 14 vascular9%,

otherunknown

55%

median

(IQR),

LA2D<=53m

m1.9yr

(0.8,3.2),

LA2D>53mm

1.8(0.9,3.2)

nd 0 median(IQR),

LA2D<=53mm

0%(0,0),

LA2D>53mm

0%(0,4)

27336396 Kang 2016 UNOS US 2005-2013 3.9years 104632 AllTxp KTxpalone,notforeigndonor

kidneyrecipients







comorbidity

nd nd nd 0 nd

20801565 Kasiske 2010 USRDS/OPTN US 2000-2006 5years? 59091 AllTxp deceaseddonor >=18yo excludedmultiorganrecipientsandprior

recipientsofnonkidneyorgans

50(13) nd 61 31 6 nd nd nd nd unknown2.4% 25 22 25 systicdisease

8.8%,othernot

reported18.7%

nd nd nd nd







Race,Black,%

Race,Asian(total),%

Race,EastAsian,%

Race,SouthAsian,%

Race,MiddleEasten,%

Race,Hispanic,%





Dialysisduration

Dialysismodality

Repeatorh/oKTxp,%


21449945,27391198,22156753 Molnar 2011,2015,2016SRTR,DaVita US 2001-2007 median:717

days,IQR

(356,1206)

14508 AllTxp FirstKTxp,onHDorPD

beforeTxp

nd nd 48(14) 61 nd 27 nd nd nd nd nd nd nd nd 27reportedas

comorbidity

nd 0-6m12%,

6-24m29%,

2-5y36%,

>5y23%

HD86%,PD

14%

0 10.1%(24.0)

8961 AllTxp FirstKTxp,onHDbeforeTxp nd Excludedptswithoutelectronically

recordedserumalbuminlevelsinthelast

quarterpriortotransplantation,lacked

datafromthebaselinequarter,with

outliervaluesforage

10083 AllTxp FirstKTxp,onHDbeforeTxp >=18yo nd

19353768 Mulay 2009 USRDS US 1990-2003 median51

months

41272 primarcause

ofrenal

failurewas

primaryor

secondary

GN

firstKTxp nd nd 40.2(14.9) 56.7 70.8 21.9 nd nd nd nd nd 7.3 100 0 0 0 0-12months

27.8%,12-

36months

37.3%,>36

monthd,

26.2%

nd 0 >50%7.8%

26569067 Naik 2016 OPTN/UNOS US 2001-2009 median5.5-

6.0years

108654 AllTxp FirstKTxp Adults Noh/ootherorganTxp(BMIdata

available,althoughnotmentionedinthe

article)

49(13) 58 54 26 5 nd nd nd 14 2 nd nd nd nd nd nd 0 <=20%60%,

>20%9%







Race,Black,%

Race,Asian(total),%

Race,EastAsian,%

Race,SouthAsian,%

Race,MiddleEasten,%

Race,Hispanic,%





Dialysisduration

Dialysismodality

Repeatorh/oKTxp,%


26102616 Opelz 2016 CTS Germany 1995-2012 10years 46548 AllTxp FirstKTxp >=18years Noh/ocombinedorganTxp,smoking

statuswasdocumentedatthetimeofTxp

>60yo:18% 62 73 nd nd nd nd nd nd nd,30% nd nd nd nd nd nd 0 nd

24070588 Pieloch 2014 UNOS US 2001-2006 3years 30132 AllTxp FirstTxp adults excludedptwithmultiorganTxp 48.4(13.9) 57 56 22 nd nd nd nd 13 unknown8% nd nd nd nd nd 82 0 nd

25758804 Pieloch 2015 OPTN/UNOS US 2000-2008 3years 100261 AllTxp nd adults excludedptwithmultiorganTxp 18-4949%,50-6438%,>=6513% nd nd nd nd nd nd nd nd nd nd nd 29%reportedas

comorbidity

nd 0years10%,

0-455%,4

24%

nd nd nd

21566110 Reddy 2011 OPTN/UNOS US 2001-2007 3years 75681 AllTxp FirstTxp >18yo excludedmultiorganTxp,ptwithpre-Txp

HCVinfection,includedptwithatleast

onefollow-upvisitreportedto

OPTN/UNOS

>=60yo26% 60 56 23 5 nd nd nd 13 unknown2.2% 20 23.4 25 unknown21% no19%,<1

year18%,1-

3years31%,

>=3years

33%

nd 0 >=10%18%

21415312 Streja 2011 SRTR/MHD US 2001-2007 2.3years 10090 AllTxp FirstTxp nd nd 49(13) 51 nd 27 4 nd nd nd 15 nd nd nd 45%as

comorbidity

nd <6m12%,6-

24m29%,2-

5y37%,>

5y23%

nd 0 10.3(24.0)

25135680 Wightman 2014 UNOS US 2008-2011 nd 2076 AllTxp FirstTxp,excludedmulti-

organTxp

children nd <5y10%,5-12y31%,13-18y59% 57 50 19 3 nd nd nd 27 American

Indian/Alaska

Native0.7%,

native

Havaiian/Othe

r0.4%,

multiracial1%

15 0 0 structural37%,

FSGS15%,other

notreported

34%,missing

1.4%

nd 0 nd

25098499 Xia 2014 SRTR/OPTN US 2000-2013 3years 486 AllTxp KidneyaloneTxp,deceased

donor

adults ExcludedHBVsAg+,hadmissingor

unknownHIVorHCVserostatusor

receivedapreviouslivertransplant

50.7(11.4) 72 nd 62 nd nd nd nd nd nd nd nd 21 nd >3years

72%

nd 8 >30%,30%

26636735 Barraclough 2016 ANZDATA Australia,NewZealand 2000-2012 nd 7826 AllTxp Kidneytxpalone,recipients

ofmulitpleorgantransplants

wereexcluded

adults Recipientsofmulitpleorgantransplants

wereexcluded

18-44:38.6%

46-64:52.6%

65+:8.8%

62.8 nd nd nd nd nd nd nd indigenous

Australian:

3.5%

nonindigenous

Australian:

96.5%

nd nd 14 nd nd nd 2+graft

number:8.0%

0-9%:72.3%

10-49%:17.2%

≥50%:10.1%







Race,Black,%

Race,Asian(total),%

Race,EastAsian,%

Race,SouthAsian,%

Race,MiddleEasten,%

Race,Hispanic,%





Dialysisduration

Dialysismodality

Repeatorh/oKTxp,%


28361229 Ladhani 2017 ANZDATA Australia,NewZealand 1994-2013 median8.4

years

750 Children

receiving

firsttxp

Kidneytxp 2-18years registryisacomprehensivedatabaseofall

childrenandadultswhohaverecevied

renalreplaccementtherapysince1965in

AustraliaandNewZealand

2-6:23.6%

7-10:20.9%

11-15:28.8%

16+:26.7%

58.3 79.6 nd nd nd nd nd nd indigenous:

8.3%

other:16.7%

30.8 nd nd 69.2 nd nd 0 0-25:87.2

26-50:4.1

51-75:4.3

76-100:2.9

26924061 Pruthi 2016 UKRR(UKRenalRegistry) UK 1997-2009 nd(through

December

2012)

4750 Incident

renal

transplant

patientsin

theUK,aged

>16years

witha

primary

renal

diagnosisof

GNorAPKD

Incidentrenaltransplant

patientswithprimaryrenal

diagnosisofGNorAPKD

>16years nd GNgroup:median45

ADPKDgroup:median53

62 89 4 5 nd nd nd nd 2 62.6 nd nd ADPKD:37.4 GNgroup:

median1.9

years

ADPKD

group:

median1.6

years

nd nd nd







Race,Black,%

Race,Asian(total),%

Race,EastAsian,%

Race,SouthAsian,%

Race,MiddleEasten,%

Race,Hispanic,%





Dialysisduration

Dialysismodality

Repeatorh/oKTxp,%


PREDICTORSOFOTHEROUTCOMES27336396 Kang 2016 UNOS US 2005-2013 3.9years 104632 AllTxp KTxpalone,notforeigndonor

kidneyrecipients







comorbidity

nd nd nd 0 nd

17198258 Shah 2006 OPTN/UNOS US 2004-2005 306days 15309 AllTxp FirstKTxp >20yo includedthosehadatleastonf/uandnon-

diabetic

>60yo,17.8% 59 55.8 23.3 5.1 nd nd nd 11.9 notspecified

3.9%

nd 77.6%reported

ascomorbidity

0 nd nd nd 0 nd

PRE-EMPTIVEvs.EARLYDIALYSIS







Race,Black,%

Race,Asian(total),%

Race,EastAsian,%

Race,SouthAsian,%

Race,MiddleEasten,%

Race,Hispanic,%





Dialysisduration

Dialysismodality

Repeatorh/oKTxp,%


27653837 Amaral 2016 USRDS US 2000-2012 4.8years 7527 AllTxp nd <18yo includedthoseenteredmedicareprogram 10.8(5.3) 59 71 17 nd nd nd nd 22(hispanic

white)

12 15(including

6%secondary

GN)

nd nd CAKUT46%,FSGS

13%,lupus2%,

othersunknown

25%

nd nd nd <20%73%,20-

80%19%,>80%

8%

23371953 Grams 2013 SRTR US 1995-2011 nd 18976 deceased-

donorktxp

firstKTxp adults nd 52.7(12.5) 44.8* 57.3* 20.3* nd nd nd nd nd 22.4* 7.7* 5* 5.5* 81.8* nd nd 0 <=40%55%

KDIGO-TransplantCandidateGuidelineTopic:RegistrystudiesCategoricaloutcomes

Pubmedid Authors Year

PREDICTORSOFMORTALITY23295317 Cannon 2012

24138318 Farrugia 2014

20814353 Huang 2010

26660200 Ilori 2015

24009216 Kainz 2013

27336396 Kang 2016

26147285 Krishnan 2015

26720436 Lynch 2016

Outcome Outcomedefinition

%w/outcome %w/ooutcome

PrimaryPredictor Predictordefinition %w/predictor

%w/opredictor

Metric Estimate,mean(95%CI)

Pvalue Adjustment,Othercovariates(listonce) Methodologicalquality

Notes

Mortality all-cuasemortality

3.9%1year,7.5%3years,13.4%5years

96.9%1year,92.5%3years,86.6%5years

ClassIObesity BMI30-35 20 70.3 HR 0.92(0.86,0.99) 0.025 recipientage,race,gender,CVAasdonorcauseofdeath,donortype,coldischemictime,HLAmismatch,othercausesofrenalfailure,previousKTxp

A

ClassIIObesity BMI30-35 7.7 HR 1.06(0.96,1.18) 0.244ClassIIIObesity BMI>=40 2.1 HR 1.15(0.95,1.39) 0.151Diabeticnephropathy nd 21 79 HR 1.61(1.50,1.73) <0.001Hypertensivenephropathy nd 16 84 HR 1.10(1.02,1.19) 0.012

Mortality 1-yearmortalitypostkidneyTxp

566deaths nd Age50-59(vs<50) Age50-59(vs<50) nd nd HR 2.38(1.95,2.90) <0.001 sex,race,livingdornorTxp,allograftfailure A

Age60-69(vs<50) Age60-69(vs<50) nd nd HR 4.46(3.68,5.39) <0.001Age70-79(vs<50) Age70-79(vs<50) nd nd HR 7.62(5.84,9.94) <0.001Age>=80(vs<50) Age>=80(vs<50) nd nd HR 15.72(4.98,49.60) <0.001Socioeconomicdeprivation2(vs1) Socioeconomicdeprivation2(IMD2010)(vs

1),1-mostdeprivedalive21.9%,death25.6%

alive21.9%,death25.6%

HR 0.84(0.68,1.05) 0.124

Socioeconomicdeprivation3(vs1) Socioeconomicdeprivation3(IMD2010)(vs1),1-mostdeprived


HR 0.86(0.69,1.08) 0.193

Socioeconomicdeprivation4(vs1) Socioeconomicdeprivation4(IMD2010)(vs1),1-mostdeprived


HR 0.86(0.68,1.08) 0.19

AMI acutemyocardialinfarction alive2.4%death8.7%


HR 1.52(1.15,2.01) 0.003

CHF congestivehearfailure alive0.6%,death2.7%


HR 1.51(0.77,2.93) 0.229

PVD perpheralvasculardisease alive0.7%,death2.7%


HR 1.70(1.17,2.47) 0.006

CVA cerebralvascularaccident alive1.4%,death4.6%


HR 1.66(0.91,3.03) 0.097

DM diabetes alive15.2%,death25.4%


HR 1.64(1.38,1.93) <0.001

Mortality all-causemortality?

nd nd Age>=80(vs.60-69) nd 0.6 79.8 HR 2.42(1.91,3.06) nd transplantyear,recipientage,recipientgender,recipientrace,dialysisduration,retransplantation,peakPRA,recipientcomorbidities(diabetes,cardiovasculardisease,peripheralvasculardisease,andcerebrovasculardisease),donortype,donorage,degreeofhumanleukocyteantigenmismatch,inductiontherapy,tacrolimususe,mycophenolateuse,andsteroiduse

A

Age70-79(vs.60-69) nd 19.6 HR 1.42(1.34,1.51) nd

Death nd 37.4% 62.6% Age 10-yearchange,allpts>=60yo nd nd HR 1.47(1.42,1.52) nd raceandethnicity,anyacuterejection,end-stagerenaldisease(ESRD)etiology,sex,humanleukocyteantigen(HLA)mismatch,pretransplantaitondialysis,typeofdonor,donorage,coldischemiatime,insurance,neighborhoodpoverty,andperiodoftransplantation

A

Death deathwithandwithoutcensoredgraftloss

33.6%inupperLA2Dstratumin10years,16.3%inlowerLA2Dstratumin10years

66.4%inupperLA2Dstratumin10years,83.7%inlowerLA2Dstratumin10years

leftatrialdiameter(mm) continuousvariablebyechoinmm na na HR 1.06(1.03,1.08) <0.001 leftatrialdiameter,rightventriculardiameter,periphervasculardisease,HBG,immunosuppression,calcineurininhibitoruse,afib

B

rightventriculardiameter(mm) continuousvariablebyechoinmm na na HR 0.95(0.90,1.01) 0.12periphervasculardisease(yesversusno) nd,yesvsno 13 87 HR 4.60(2.20,9.60) <0.001


8-yearspost-Txp:w/pre-Txpskincancer42.8%,w/opre-Txpskincancer28.4%


Pre-Txpskincancer(vs.nopre-Txpskincancer) nd 1.6 98.4 HR 1.20(1.07,1.34) <0.001(fromlog-ranktest)

adjustedforsex,age,BMI,ethnicity,EBV,HBV,HCV,serostatus,dialysisduration,andinductiontherapy

B

Pre-Txpskincancerexcludingthosewithsolidcancer(vs.nopre-Txpskincancer)

nd 1.4 98.6 HR 1.17(1.04,1.32) <0.001(fromlog-ranktest)

adjustedforsex,age,BMI,ethnicity,EBV,HBV,HCV,serostatus,dialysisduration,andinductiontherapy

.

Death allcausemortality

2.8% 97.2% BMI<18.5 BMI<18.5 2.9 41.1 HR 1.96(0.90,4.30) 0.0912 recipientgernder,age,race,primarydiagnosis,donorstatus,age,sex,race,rejection,HLAmismatch

B

BMI25-<30 BMI25-<30 35.5 HR 0.94(0.68,1.29) 0.6858BMI30-<35 BMI30-<35 16.8 HR 0.73(0.47,1.13) 0.1628BMI35-<40 BMI35-<40 3.3 HR 0.48(0.15,1.53) 0.2163BMI40+ BMI40+ 0.5 HR 1.14(0.16,8.28) 0.8943

Mortality all-causemortality

nd nd Age ascontinuousvariable,peryr na na HR 1.04(1.04,1.04) <0.0001 sex,race,h/oTxp,dialysisvintage,donortype,newonsetofcomorbidity,no.inpatientdaysinpre-Txpyear

B

Diabetes nd 29.2 70.8 HR 1.39(1.31,1.47) <0.0001CHF nd 12.7 87.3 HR 1.22(1.13,1.31) <0.0001CVD nd 3.1 96.9 HR 1.16(1.02,1.32) 0.02PVD nd 4.5 95.5 HR 1.15(1.03,1.27) 0.01COPD nd 1.7 98.3 HR 1.20(1.02,1.41) 0.03


21449945,27391198,22156753 Molnar 2011,2015,2016

26102616 Opelz 2016

24070588 Pieloch 2014

25758804 Pieloch 2015

21566110 Reddy 2011

21415312 Streja 2011

25135680 Wightman 2014




%w/opredictor



Notes

Mortality Graftfailurecensoredall-causedeath

7.0 93.0 PDvs.HD nd 14.0 86.0 HR 0.57(0.38,0.87) 0.009 A

Death,all-cause,graftlosscensored

all-causemortality

8.0 92.0 albumin by0.2g/dl,ascontinuous nd nd HR 0.87(0.82,0.93) <0.001 age,gender,race-ethnicity,diabetesmellitus,dialysisvintage,primaryinsurance,maritalstatus,standardizedmortalityratioofthedialysisclinicduringentryquarter,dialysisdoseasindicatedbyKt/V(singlepool),presenceorabsenceofadialysiscatheterandresidualrenalfunctionduringtheentryquarter,bodymassindex(BMI),thenormalizedproteinnitrogenappearance(nPNA)andserumorbloodconcentrationsofTIBC,ferritin,phosphorus,calcium,bicarbonate,peripheralwhitebloodcellcount(WBC),lymphocytepercentageandhemoglobin,donortype,donorage,panelreactiveantibody(PRA)titer(lastvaluepriortotransplant),numberofHLAmismatches,coldischemiatimeandextendeddonorcriteria

albuminhasnosignificantinteractingeffectwithage,gender,race,

hemoglobin,BMI,DM


9.9%intheentirecohortof15125pt

90.1 Age18-34(vs.50-64) nd nd nd HR 0.41(0.31,0.54) <0.001 recipientrace,typeofinsurance,timeondialysis,donor'sage,DM

Age35-49(vs.50-64) nd nd nd HR 0.60(0.50,0.71) <0.001Age>=65(vs.50-64) nd nd nd HR 1.63(1.40,1.90) <0.001DM(presensevs.absence) nd 37.0 63.0 HR 1.53(1.34,1.74) <0.001CAD(presensevs.absence) nd 7.0 93.0 HR 1.38(1.15,1.65) <0.001PVD(presencevs.absence) nd 7.0 93.0 HR 1.38(1.13,1.69) 0.002Serumalbumin by1g/dl,ascontinuous nd nd HR 0.62(0.52,0.75) <0.001

Death,all-cause nd 6068events nd Stoppedsmoking(vs.Neversmoking) nd 22.1 67.6 HR 1.1(1.0,1.2) <0.001

Continuedsmoking(vs.Neversmoking) nd 10.3 HR 1.6(1.5,1.8) <0.001DeathwithafunctioninggraftduetoCVD

nd nd nd Stoppedsmoking(vs.Neversmoking) nd 22.1 67.6 HR 1.1(1.0,1.3) 0.075

Continuedsmoking(vs.Neversmoking) nd 10.3 HR 1.6(1.4,1.9) <0.001Deathwithafunctioninggraftduetomalignancy

nd nd nd Stoppedsmoking(vs.Neversmoking) nd 22.1 67.6 HR 1.4(1.2,1.7) 0.001

Continuedsmoking(vs.Neversmoking) nd 10.3 HR 2.6(2.1,3.1) <0.001

Mortality 3year,allcausemortality?

nd nd Morbidobesity BMI35-40kg/m2 20 80 HR 1.03(0.96,1.12) 0.36 C

Mortality all-causemortality

KTMIscore=01.8%,13.4%,26.3%,310.3%,415.2%,519.2%,624.0%,>=725.3%

KTMIscore=098.2%,196.6%,293.7%,389.7%,484.8%,580.8%,676.0%,>=774.7%

KTMIscore1(vsscore0) KidneyTransplantMorbidityIndexscore=1 22.2 6.4 HR 1.85(1.45,2.36) <0.001 humanleukocyteantigenmismatch,coldischemictime,donorage,anddonortype

.

KTMIscore2(vsscore0) KidneyTransplantMorbidityIndexscore=2 27.6 HR 3.11(2.46,3.94) <0.001KTMIscore3(vsscore0) KidneyTransplantMorbidityIndexscore=3 22.8 HR 5.00(3.96,6.31) <0.001KTMIscore4(vsscore0) KidneyTransplantMorbidityIndexscore=4 13.3 HR 7.37(5.83,9.32) <0.001KTMIscore5(vsscore0) KidneyTransplantMorbidityIndexscore=5 5.5 HR 9.41(7.41,11.94) <0.001KTMIscore6(vsscore0) KidneyTransplantMorbidityIndexscore=6 1.7 HR 12.51(9.45,15.63) <0.001KTMIscore>=7(vsscore0) KidneyTransplantMorbidityIndexscore>=7 0.5 HR 13.03(9.68,17.54) <0.001

MortalityinlivingdonorTxp

allcausemortality?

5yearsallrecipients,HBV+14.7%,HBV-14.4%


HBVinfection(vs.HBV-) HBsAg+ve allrecipients1.8%

allrecipients98.2%

HR 0.98(0.59,1.63) nd

MortalityindeceaseddonorTxp

allcausemortality?




allrecipients98.2%

HR 1.09(0.88,1.36) nd

Mortality graftfailurecensoreddeath

7.8% 92.2% BMI ascontinuousvariable,basedoneach1kg/m2higherBMI

na na HR 0.99(0.98,1.02) 0.91 age,sex,race,ethnicity,diabetesmellitus,dialysisvintage,primaryinsurance,maritalstatus,thestandardizedmortalityratioofthedialysisclinicduringentryquarter,dialysisdoseasindicatedbyKt/V(singlepool),presenceorabsenceofadialysiscatheter,andresidualrenalfunctionduringtheentryquarter(i.e.,urinaryureaclearance)

B

Creatinine ascontinuousvariable,basedoneach1mg/dlhigherscr

na na HR 0.91(0.86,0.95) <0.001

Mortality allcausemortality

0.9% 99.1% Definiteintelectualdisability identifiedas“definitelycognitivedelay/impairment”bytheircenter

5.6 84.1 HR 0.3(0.2,12.2) 0.752 ageinyears(<5,5–12,13–18),malegender,race(white/nonwhite),etiology(structural,FSGS,GN,other),deceaseddonor(Y/N),coldischemiatime>24hrs(Y/N),HLAmatch,PRA/CPRA(<10%,10–<80%,80–100%)

.

Probableintelectualdisability “probable”or“questionable”cognitivedelay/impairment,“reducedacademicload/nonparticipation,”or“delayedgradelevel/specialeducation”

10.3 HR 0.2(0.1,1.3) 0.752


25098499 Xia 2014

26636735 Barraclough 2016

28010785 Lim 2017

28361229 Ladhani 2017

26924061 Pruthi 2016




%w/opredictor



Notes

Patientsurvival patientmortalityfromanycausefollowingtransplantation

12.6 87.4 HIVseropositive(vs.negative) nd 50.0 50.0 HR 0.80(0.39,1.64) nd

Overallsurvival Patientdeath

333 7171 ≥Obese nd nd nd HR 0.96(0.77,1.20) nd age,comorbidities,BMI,smokingstatus,transplantera,graftnumber,HLAmismatches,PRA,ischemictime,donorsource,andtransplantstate,andincludedaracebyruralinteractionterm

A

Overweight nd nd nd HR 0.91(0.75,1.10) nd age,comorbidities,BMI,smokingstatus,transplantera,graftnumber,HLAmismatches,PRA,ischemictime,donorsource,andtransplantstate,andincludedaracebyruralinteractionterm

Smoker nd nd nd HR 1.20(1.01,1.43) nd age,comorbidities,BMI,smokingstatus,transplantera,graftnumber,HLAmismatches,PRA,ischemictime,donorsource,andtransplantstate,andincludedaracebyruralinteractionterm

CVD cerebrovasculardisease nd nd HR 1.39(1.01,1.91) nd age,comorbidities,BMI,smokingstatus,transplantera,graftnumber,HLAmismatches,PRA,ischemictime,donorsource,andtransplantstate,andincludedaracebyruralinteractionterm

DM nd nd nd HR 1.43(1.14,1.78) nd age,comorbidities,BMI,smokingstatus,transplantera,graftnumber,HLAmismatches,PRA,ischemictime,donorsource,andtransplantstate,andincludedaracebyruralinteractionterm

Age45-64 nd 52.6 47.4 HR 0.63(0.56,0.71) nd age,comorbidities,BMI,smokingstatus,transplantera,graftnumber,HLAmismatches,PRA,ischemictime,donorsource,andtransplantstate,andincludedaracebyruralinteractionterm

Age≥65 nd 8.8 91.2 HR 0.47(0.37,0.60) nd age,comorbidities,BMI,smokingstatus,transplantera,graftnumber,HLAmismatches,PRA,ischemictime,donorsource,andtransplantstate,andincludedaracebyruralinteractionterm

All-causemortality nd nd nd Age<40years(DMvs.noDM) nd 34.7 65.3 HR 5.16(2.84,9.35) nd donorage,donortype,waitingtime,prevalentconrdiovasculardisease,ethicorigin,totalischemictime,prevalentperipheralvasculardisease,prevalentcerebrovasculardisease,BMI,smoking,era,andpeakpanelreactiveantibody

A

Age40-55years(DMvs.noDM) nd 37.9 62.1 HR 2.08(1.62,2.66) nd donorage,donortype,waitingtime,prevalentconrdiovasculardisease,ethicorigin,totalischemictime,prevalentperipheralvasculardisease,prevalentcerebrovasculardisease,BMI,smoking,era,andpeakpanelreactiveantibody

Age>55years(DMvs.noDM) nd 27.4 72.6 HR 1.41(1.17,1.71) nd donorage,donortype,waitingtime,prevalentconrdiovasculardisease,ethicorigin,totalischemictime,prevalentperipheralvasculardisease,prevalentcerebrovasculardisease,BMI,smoking,era,andpeakpanelreactiveantibody

Overalldeath all-causemortliaty

53 697 Obese nd 8.1 91.9 HR 0.80(0.25,2.61) nd adjustedforageattransplant,HLAmismatch,andyearoftransplant

A

Overweight nd 17.2 82.8 HR 0.85(0.38,1.92) nd adjustedforageattransplant,HLAmismatch,andyearoftransplant

Underweight nd 64.4 35.6 HR 1.18(0.25,2.61) nd adjustedforageattransplant,HLAmismatch,andyearoftransplant

Patientsurvival nd nd nd ADPKD nd nd nd HR reference reference nd A

CrescenticGN nd nd nd HR 1.11(0.65,1.90) 0.7 adjustedforage,gender,typeoftransplant,ethnicity,donorage,timeondialysispretransplantation,HLAmismatch,coldischemictime,andgraftfailure.

FSGS nd nd nd HR 1.12(0.75,1.66) 0.6 adjustedforage,gender,typeoftransplant,ethnicity,donorage,timeondialysispretransplantation,HLAmismatch,coldischemictime,andgraftfailure.

GNhistologicallynotexamined nd nd nd HR 1.13(0.78,1.63) 0.5 adjustedforage,gender,typeoftransplant,ethnicity,donorage,timeondialysispretransplantation,HLAmismatch,coldischemictime,andgraftfailure.

GNhistologicallyproven nd nd nd HR 1.13(0.86,1.49) 0.4 adjustedforage,gender,typeoftransplant,ethnicity,donorage,timeondialysispretransplantation,HLAmismatch,coldischemictime,andgraftfailure.

IgAnephropthy nd nd nd HR 1.18(0.92,1.52) 0.2 adjustedforage,gender,typeoftransplant,ethnicity,donorage,timeondialysispretransplantation,HLAmismatch,coldischemictime,andgraftfailure.


PREDICTORSOFGRAFTLOSS24370342 Tancredi 2014

12110738 Briganti 2002

23295317 Cannon 2012

21797974

Clayton 2011

22124283 Foster 2011




%w/opredictor



Notes

Lupusnephritis nd nd nd HR 1.81(1.13,2.90) 0.013 adjustedforage,gender,typeoftransplant,ethnicity,donorage,timeondialysispretransplantation,HLAmismatch,coldischemictime,andgraftfailure.

Membranousnephropathy nd nd nd HR 0.91(0.61,1.36) 0.7 adjustedforage,gender,typeoftransplant,ethnicity,donorage,timeondialysispretransplantation,HLAmismatch,coldischemictime,andgraftfailure.

MPGNtypeII nd nd nd HR 1.03(0.65,1.62) 0.9 adjustedforage,gender,typeoftransplant,ethnicity,donorage,timeondialysispretransplantation,HLAmismatch,coldischemictime,andgraftfailure.

MPGNtypeII nd nd nd HR 4.68(2.03,10.81) 0.0003 adjustedforage,gender,typeoftransplant,ethnicity,donorage,timeondialysispretransplantation,HLAmismatch,coldischemictime,andgraftfailure.

GPA nd nd nd HR 0.78(0.47,1.29) 0.3 adjustedforage,gender,typeoftransplant,ethnicity,donorage,timeondialysispretransplantation,HLAmismatch,coldischemictime,andgraftfailure.

Preemptivetransplantation nd nd nd HR 0.72(0.49,1.06) 0.1 adjustedforage,gender,typeoftransplant,ethnicity,donorage,timeondialysispretransplantation,HLAmismatch,coldischemictime,andgraftfailure.

<1yearondialysis nd nd nd HR 0.68(0.51,0.90) 0.01 adjustedforage,gender,typeoftransplant,ethnicity,donorage,timeondialysispretransplantation,HLAmismatch,coldischemictime,andgraftfailure.

1-3yearsondialysis nd nd nd HR reference reference nd>3yearsondialysis nd nd nd HR 1.57(1.29,1.92) <0.0001 adjustedforage,gender,typeoftransplant,

ethnicity,donorage,timeondialysispretransplantation,HLAmismatch,coldischemictime,andgraftfailure.

Graftloss,1year nd 0.05 0.95 Serumalbumin<2.5(vs.>=3.5) <2.5g/dl 5.1 72 HR 1.71(1.09,2.70) nd recipientage,sex,ethnicity,causeofCKD,OPTNregionwheretransplantoccurred,yearoftransplant,needforpretransplantationdialysis,timeonthedeceaseddonorwaitlist,donorsource(deceasedorliving),donorageandcauseofdeath,HLAmismatchlevel,andcoldischemiatime.

A

Serumalbumin2.5-3.4(vs.>=3.5) 2.5-3.4g/dl 22.9 HR 1.36(1.04,1.78) nd

graftlossduetoGNrecurrence

nd 3.5% 96.5% MesangiocapillaryglomerulonephritistypeIvs.meanriskforallcategoriesofGN

nd HR 2.91(1.53-5.55) 0.001 Hazardratiosforfactorsthatremainedindependentlypredictiveinmultivariableanalysiswereadjustedforallotherindependentlypredictivefactors

A

FSGSvs.meanriskforallcategoriesofGN nd HR 2.03(1.19,3.44) 0.009membranousGNvs.meanriskforallcategoriesofGN nd HR nd nsIgAnephropathyvs.meanriskforallcategoriesofGN nd HR nd nsPauci-immunecrescenticglomerulonephritisvs.meanriskforallcategoriesofGN

nd HR nd ns

othertypesofGN nd HR 0.30(0.13,0.66) 0.003Age 10-yearchange nd nd HR nd nspeakPRA per10%increment nd nd HR 1.10(1.00,1.21) 0.05Dialysisduration per1-yearincrement nd nd HR nd ns

Graftloss(notdeath-censored)

patientswhoeitherdiedorexperiencedgraftfailurewereconsideredtohavefailed

6%1year,26%5years 93%1year,74%5years

ClassIObesity BMI30-35 20 70.3 HR 1.00(0.95,1.05) 0.901 recipientage,race,gender,CVAasdonorcauseofdeath,donortype,peakPRA,coldischemictime,HLAmismatch,othercausesofrenalfailure,previouskidneytransplant

A

ClassIIObesity BMI30-35 7.7 HR 1.15(1.07,1.24) <0.001ClassIIIObesity BMI>=40 2.1 HR 1.26(1.11,1.43) <0.001Diabeticnephropathy nd 21 79 HR 1.34(1.27,1.42) <0.001Hypertensivenephropathy nd 16 84 HR 1.09(1.04,1.15) 0.001

graftlossduetoIgANrecurrence

nd 3.6% 96.4% Age 10-yearchange nd nd SHR 0.87(0.67,1.13) 0.31 age,sex,HLAmismatch,dialysisduration,transplantera,steroiduse

A

Dialysisduration6monthsto<1year(vs.<6months) nd 46.4 53.6 SHR 0.73(0.35,1.49) ndDialysisduration1yto<5years(vs.<6months) nd 71.3 28.7 SHR 0.50(0.25,0.98) ndDialysisduration>=5years(vs.<6months) nd 40.8 59.2 SHR 0.40(0.09,1.74) ndEra1998-2007(vs.1988-1992) nd 63% 37% SHR 0.26(0.10,0.66) nd

death-censoredgraftloss nd 35.1 64.9 Age0-4yvs.25-29y ageattimeofgraftloss,nottimeoftransplant nd nd HR 0.94(0.79,1.13) 0.5 age,sex,SES,primarydisease,race,donorage,livingdonor,durationofdialysis,HLAmismatch,eraoftransplant

A

Age5-9yvs.25-29y ageattimeofgraftloss,nottimeoftransplant nd nd HR 0.60(0.53,0.68) <0.0001


Age13-16yvs.25-29y ageattimeofgraftloss,nottimeoftransplant nd nd HR 0.91(0.84,0.98) 0.01


23406350 Heaphy 2013

20814353 Huang 2010

26660200 Ilori 2015

24009216 Kainz 2013

27336396 Kang 2016

20801565 Kasiske 2010




%w/opredictor



Notes





Age>=40yvs.25-29y ageattimeofgraftloss,nottimeoftransplant nd nd HR 0.65(0.62,0.68) <0.0001

SESlow-midquartilevs.lowestquartile nd 18.9 18.8 HR 0.95(0.91,0.98) 0.003SEShigh-midquartilevs.lowestquartile nd 26.3 18.8 HR 0.91(0.88,0.94) <0.0001SEShighestquartilevs.lowestquartile nd 36 18.8 HR 0.83(0.80,0.86) <0.0001GNvs.CAKUT congenitalanomaliesofthekidneysorurinary

tract28.3 8.2 HR 1.03(0.98,1.09) 0.2

FSGSvs.CAKUT congenitalanomaliesofthekidneysorurinarytract

8.3 8.2 HR 1.13(1.07,1.20) <0.0001

DMvs.CAKUT congenitalanomaliesofthekidneysorurinarytract

nd 8.2 HR 1.02(0.96,1.07) 0.6

Otherprimarydiseasevs.CAKUT congenitalanomaliesofthekidneysorurinarytract

32.3 8.2 HR 1.01(0.96,1.07) 0.6

Unknownprimarydiseasevs.CAKUT congenitalanomaliesofthekidneysorurinarytract

22.9 8.2 HR 0.85(0.80,0.90) <0.0001

Dialysisduration per1-yearincrement nd nd HR 1.02(1.01,1.02) <0.0001

graftloss nd 71.8 28.2 PKDvs.noPKD nd 9.6 90.4 HR 0.75(0.72,0.78) <0.0001 recipientage,race,gender,PKDstatus,diabetesstatus,serumPRApercent,income,primaryinsurance,obesitystatusandinteractionsbetweenECDstatusandrecipientcharacteristics

A

PRA1-30%vs.0% nd 15.9 73.1 HR 1.04(1.00,1.07) 0.0245PRA31-80%vs.0% nd 5.3 73.1 HR 1.14(1.09,1.21) <0.0001PRA>=81%vs.0% nd 2.4 73.1 HR 1.21(1.12,1.31) <0.0001BMI>30vs.<=30 nd 26.1 73.9 HR 1.13(1.10,1.16) <0.0001Highschooleducation/GEDvs.none/gradeschool nd 38.5 6.4 HR 1.09(1.04,1.14) 0.0002Somecollegevs.bachelordegreevs.none/gradeschool nd 29.2 6.4 HR 0.96(0.92,1.01) 0.1044Graduatedegreevs.none/gradeschool nd 4.3 6.4 HR 0.95(0.89,1.02) 0.1282

Graftfailure Death-censoredgraftloss

2year60-69yo7%,70-79yo8%,>=80yo9%

2year60-69yo93%,70-79yo92%,>=80yo91%

Age>=80(vs.60-69) nd 0.6 79.8 HR 0.89(0.57,1.39) nd transplantyear,recipientage,recipientgender,recipientrace,dialysisduration,retransplantation,peakPRA,recipientcomorbidities(diabetes,cardiovasculardisease,peripheralvasculardisease,andcerebrovasculardisease),donortype,donorage,degreeofhumanleukocyteantigenmismatch,inductiontherapy,tacrolimususe,mycophenolateuse,andsteroiduse

A

Age70-79(vs.60-69) nd 19.6 HR 1.02(0.93,1.11) nd

Graftloss nd 14.1% 85.9% Age 10-yearchange,allpts>=60yo nd nd HR 0.94(0.89,1.00) nd raceandethnicity,anyacuterejection,end-stagerenaldisease(ESRD)etiology,sex,humanleukocyteantigen(HLA)mismatch,pretransplantaitondialysis,typeofdonor,donorage,coldischemiatime,insurance,neighborhoodpoverty,andperiodoftransplantation

A

Graftloss theneedforretransplantationorpermanentreturntodialysis

N=119 nd rightatrialdiameter(mm) continuousvariablebyechoinmm na na HR 1.04(1.02,1.07) 0.001 rightatrialdiameter,cerebrovasculardisease,periphervasculardisease,coronaryheartdisease,HBG,ageatTxp,donorage,immunosuppression,calcineurininhibitoruse,afib,yearofTxp

A

cerebrovasculardisease(yesversusno) nd,yesvsno 5 95 HR 2.52(0.61,10.36) 0.16periphervasculardisease(yesversusno) nd,yesvsno 13 87 HR 2.29(0.97,5.41) 0.06coronaryheartdisease(yesversusno) nd,yesvsno 15 85 HR 0.60(0.18,1.99) 0.34

Graftfailure nd 8-yearspost-Txp:w/pre-Txpskincancer47.6%,w/opre-Txpskincancer41.4%


Pre-Txpskincancerexcludingthosewithsolidcancer(vs.nopre-Txpskincancer)

nd 1.6 98.4 HR 1.14(1.02,1.27) 0.03(fromlog-ranktest)

adjustedforsex,age,BMI,ethnicity,EBV,HBV,HCVserostatus,dialysisduration,useofinductiontherapy

A

Graftloss 5-yearpost-Txp,returntomaintenancedialysistherapy,preemptiveretransplant,ordeathwithafunctioninggraft

nd nd PrimarycauseofCKD:HTNvs.DM nd 22.4 24.9 HR 0.84(0.79,0.89) <0.001 donorage,race,RRT,recipientage,HCV,donorhistoryofHTN,primaryinsurance,traumaasdonorcauseofdeath,HLA

B

PrimarycauseofCKD:GNvs.DM nd 25.2 HR 0.77(0.73,0.82) <0.001PrimarycauseofCKD:Cysticdiseasevs.DM nd 8.8 HR 0.59(0.54,0.65) <0.001


21449945,27391198,22156753 Molnar 2011,2015,2016

19353768 Mulay 2009

26569067 Naik 2016




%w/opredictor



Notes

Graftloss Deathcensoredgraftfailure

11.4 88.6 PDvs.HD nd 14.0 86.0 HR 1.08(0.79,1.47) 0.63 age,sex,recipientrace/ethnicity,diabetesmellitus,dialysisvintage,primaryinsurance,maritalstatus,standardizedmortalityratioofthedialysisclinicduringentryquarter,andeightcomorbidities(atheroscleroticheartdisease,congestiveheartfailure,cancer,chronicobstructivepulmonarydisease,cerebrovasculardisease,hypertension,peripheralvasculardisease,andtobaccouse),bodymassindex(BMI)andninelaboratoryvariables:serumorbloodconcentrationsoftotalironbindingcapacity,ferritin,phosphorus,calcium,bicarbonate,peripheralwhitebloodcellcount(WBC),lymphocytepercentage,albumin,andhemoglobin,donortype,donorage,donorsex,panelreactiveantibody(PRA)titer(lastvaluebeforetransplant),numberofHLAmismatches,andcoldischemiatime

A

Graftloss,deathcensored graftfailure 8.8 91.2 albumin by0.2g/dl,ascontinuous nd nd HR 0.96(0.90,1.02) 0.15

Graftloss deathcensoredallograftloss

10.9%intheentirecohortof15125pt

89.1 Age18-34(vs.50-64) nd nd nd HR 1.64(1.37,1.96) <0.001 recipients'race,typeofinsurance,timeondialysis,Hgb,donor'sDM,HLAmismatch

.

Age35-49(vs.50-64) nd nd nd HR 1.25(1.07,1.45) 0.004Age>=65(vs.50-64) nd nd nd HR 0.82(0.67,1.01) 0.06PrimarycauseofESRD:HTNvs.DM nd 23.0 25.0 HR 1.51(1.21,1.89) <0.001PrimarycauseofESRD:GNvs.DM nd 23.0 HR 1.58(1.25,2.00) <0.001PrimarycauseofESRD:Cysticdiseasevs.DM nd 8.0 HR 1.14(0.83,1.58) 0.42DM(presensevs.absence) nd 37.0 63.0 HR 1.35(1.14,1.61) <0.001

graftlossduetoGNrecurrence

nd 2.6% 97.4% FSGSvs."other"* typeofGN 20.6 nd HR 1.53(1.16,2.03) <0.001 donorandrecipientage;donorandrecipientgender;donorandrecipientrace;durationofdialysispriortotransplant;peakpanelreactiveantibody;donortype(livingordeceased);donorcauseofdeathifdeceaseddonor;coldischemiatime;HLAantigenmatch;delayedgraftfunction;acuterejection;hepatitisBsurfaceantigenstatus;employmentstatus;recipientbodymassindexandtransplantyear

A *"other"includesIgMnephropathy;rapidlyprogressive

glomerulonephritis;Goodpasture’ssyndrome;Henoch-Schonlein

purpura;scleroderma;hemolyticuremicsyndrome;polyarteritis;

Wegener’sgranulomatosis;vasculitis;otherproliferative

glomerulonephritis;postinfectiousandsubacutebacterialendocarditis-

inducedglomerulonephritis.

IgAnephropathyvs."other"* typeofGN 6.6 nd HR 1.02(0.65,1.58) 0.95 *"other"includesIgMnephropathy;rapidlyprogressive






MembranousGNvs."other"* typeofGN 3.9 nd HR 1.75(1.15,2.67) 0.01 *"other"includesIgMnephropathy;rapidlyprogressive






MPGNvs."other"* typeofGN 3.9 nd HR 2.57(1.84,3.58) <0.001 *"other"includesIgMnephropathy;rapidlyprogressive






Lupusnephritisvs."other"* typeofGN 10.6 nd HR 0.72(0.49,1.06) 0.1 *"other"includesIgMnephropathy;rapidlyprogressive






unspecifiedpathologyvs."other"* typeofGN 42.2 nd HR 0.59(0.44,0.78) <0.001 *"other"includesIgMnephropathy;rapidlyprogressive






Age 10-yearchange nd nd HR 0.86(0.80,0.91) <0.001Dialysisduration1-12monthsvs.0months nd nd nd HR 2.08(1.46,2.96) <0.001Dialysisduration12-36monthsvs.0months nd 37.3 nd HR 1.71(1.18,2.48) <0.001Dialysisduration>36monthsvs.0months nd 26.2 nd HR 1.26(0.83,1.93) 0.28BMI continuous? nd nd HR 0.98(0.96,1.00) 0.02peakPRA>50%vs.<50% nd 7.8 92.2 HR 1.24(0.87,1.78) 0.24Era2001-2003vs.1990-1994 nd nd nd HR 0.39(0.24,0.64) <0.001

Graftloss center-reportedreturntodialysisorretransplantation

nd nd Underweight BMI<18.5 2.4 32.8 HR 0.96(0.88,1.05) 0.41 Recipientanddonorage,race,sex,dialysistime,coldischemiatime,HLAmismatchlevels,PRA,eraoftransplantation,donorBMI,typeofkidney(living,SCD,ECD),delayedgraftfunction,inductiontherapyandimmunosuppressionatdischarge

A

Overweight BMI25-30 33.5 HR 1.05(1.01,1.08) 0.01ClassIobesity BMI30-35 20.3 HR 1.15(1.10,1.19) <0.001ClassIIobesity BMI30-35 7.7 HR 1.21(1.15,1.28) <0.001ClassIIIobesity BMI>=40 3.4 HR 1.13(1.04,1.22) 0.002


26102616 Opelz 2016

24070588 Pieloch 2014

25758804 Pieloch 2015

21566110 Reddy 2011

21415312 Streja 2011

25135680 Wightman 2014

25098499 Xia 2014

26636735 Barraclough 2016




%w/opredictor



Notes

Graftloss nd 10521events nd Stoppedsmoking(vs.Neversmoking) nd 22.1 67.6 HR 1.1(1.0,1.1) <0.001 yearoftransplant,recipientage,sexandrace,donortype(deceasedorliving),donorage,originaldiseaseleadingtoend-stagerenalfailure,timeondialysis,pretransplantpanelreactiveantibodies,HLA-A+B+DRmismatches,increasedcardiovascularrisk(yes/noasidentifiedbyinvestigator),pretransplantcancer,typeofimmunosuppressivetherapy(calcineurininhibitors,antimetabolites,steroids,mechanistictargetofrapamycininhibitor,antibodyinductiontherapy)andsmokingstatus(neversmoked,historyofsmokingbutpatientstoppedbeforereceivingatransplant,ongoingsmokingattimeoftransplant).

C

Continuedsmoking(vs.Neversmoking) nd 10.3 HR 1.5(1.4,1.6) <0.001Graftloss,deathcensored nd 5881events nd Stoppedsmoking(vs.Neversmoking) nd 22.1 67.6 HR 1.0(1.0,1.1) 0.19

Continuedsmoking(vs.Neversmoking) nd 10.3 HR 1.4(1.3,1.5) <0.001

Graftloss 3yeargraftloss

nd nd Morbidobesity BMI35-40kg/m2 20 80 HR 1.04(0.98,1.11) 0.209 age,gender,race,functionalstatus,DM,PVD,dialysisdepency,HLAmatching,coldischemiatime,donortype

A

Graftfailure apermanentreturntodialysisordeathwithfunctioninggraft

KTMIscore=08.8%,111.8%,214.6%,318.3%,422.2%,526.0%,630.2%,>=731.3%

KTMIscore=091.2%,188.2%,285.4%,381.7%,477.8%,574.0%,669.8%,>=768.7%

KTMIscore1(vsscore0) KidneyTransplantMorbidityIndexscore=1 22.2 6.4 HR 1.30(1.16,1.45) <0.001 humanleukocyteantigenmismatch,coldischemictime,donorage,anddonortype

C

KTMIscore2(vsscore0) KidneyTransplantMorbidityIndexscore=2 27.6 HR 1.44(1.29,1.60) <0.001KTMIscore3(vsscore0) KidneyTransplantMorbidityIndexscore=3 22.8 HR 1.74(1.56,1.94) <0.001KTMIscore4(vsscore0) KidneyTransplantMorbidityIndexscore=4 13.3 HR 2.08(1.87,2.33) <0.001KTMIscore5(vsscore0) KidneyTransplantMorbidityIndexscore=5 5.5 HR 2.46(2.19,2.77) <0.001KTMIscore6(vsscore0) KidneyTransplantMorbidityIndexscore=6 1.7 HR 2.97(2.58,3.41) <0.001KTMIscore>=7(vsscore0) KidneyTransplantMorbidityIndexscore>=7 0.5 HR 3.11(2.55,3.80) <0.001

GraftlossinlivingdonorTxp

Death-censoredgraftfailure




allrecipients98.2%

HR 0.74(0.45,1.24) nd recipientage,gender,bodymassindex,race,comorbid(diabetes,hypertension,cerebrovasculardisease),dialysisduration,donorHBcAb,expandedcriteriadonor,HLADRmismatch,coldischemiatime(indeceaseddonor),inductiontherapy,andimmunosuppressantsatdischarge

A

GraftlossindeceaseddonorTxp

Death-censoredgraftfailure




allrecipients98.2%

HR 1.06(0.85,1.33) nd

Graftfailure death-censoredgraftfailure

7.1% 92.9% BMI ascontinuousvariable,basedoneach1kg/m2higherBMI

na na HR 1.01(0.99,1.03) 0.34 C

Creatinine ascontinuousvariable,basedoneach1mg/dlhigherscr

na na HR 0.96(0.81,1.00) 0.061

Graftfailure death-censoredgraftfailure

5.7% 94.3% Definiteintelectualdisability identifiedas“definitelycognitivedelay/impairment”bytheircenter

5.6 84.1 HR 1.1(0.5,2.5) 0.698 ageinyears(<5,5–12,13–18),malegender,race(white/nonwhite),etiology(structural,FSGS,GN,other),deceaseddonor(Y/N),coldischemiatime>24hrs(Y/N),HLAmatch,PRA/CPRA(<10%,10–<80%,80–100%)

C

Probableintelectualdisability “probable”or“questionable”cognitivedelay/impairment,“reducedacademicload/nonparticipation,”or“delayedgradelevel/specialeducation”

10.3 HR 0.5(0.3,2.0) 0.698

Death-censoredgraftsurvival

theearliestofre-transplantationorreturntodialysis

13.3 86.7 HIVseropositive(vs.negative) nd 50.0 50.0 HR 0.85(0.48,1.51) nd HIV/HCVcoinfection,age,race,sex,etiologyofESRD,BMI,PRA,priorKTxp,insurance,dialysisduration,Txpyear,comorbidity,HLAmismatch,coldischemiatime

A

Graftfailure nd 7177 327 ≥Obese nd nd nd HR 1.14(0.94,1.38) nd age,comorbidities,BMI,smokingstatus,transplantera,graftnumber,HLAmismatches,PRA,ischemictime,donorsource,andtransplantstate,andincludedaracebyruralinteractionterm

A

Overweight nd nd nd HR 1.05(0.89,1.23) nd age,comorbidities,BMI,smokingstatus,transplantera,graftnumber,HLAmismatches,PRA,ischemictime,donorsource,andtransplantstate,andincludedaracebyruralinteractionterm

Smoker nd nd nd HR 1.30(1.13,1.49) nd age,comorbidities,BMI,smokingstatus,transplantera,graftnumber,HLAmismatches,PRA,ischemictime,donorsource,andtransplantstate,andincludedaracebyruralinteractionterm

CVD cerebrovasculardisease nd nd HR 0.92(0.65,1.30) nd age,comorbidities,BMI,smokingstatus,transplantera,graftnumber,HLAmismatches,PRA,ischemictime,donorsource,andtransplantstate,andincludedaracebyruralinteractionterm


28361229 Ladhani 2017

26924061 Pruthi 2016




%w/opredictor



Notes

DM nd nd nd HR 1.27(1.02,1.58) nd age,comorbidities,BMI,smokingstatus,transplantera,graftnumber,HLAmismatches,PRA,ischemictime,donorsource,andtransplantstate,andincludedaracebyruralinteractionterm

Age45-64 nd nd nd HR 1.03(0.92,1.15) nd age,comorbidities,BMI,smokingstatus,transplantera,graftnumber,HLAmismatches,PRA,ischemictime,donorsource,andtransplantstate,andincludedaracebyruralinteractionterm

Age≥65 nd nd nd HR 1.17(0.97,1.40) nd age,comorbidities,BMI,smokingstatus,transplantera,graftnumber,HLAmismatches,PRA,ischemictime,donorsource,andtransplantstate,andincludedaracebyruralinteractionterm

Graftloss nd 31.3 68.7 Obese nd 8.1 91.9 HR 1.61(1.05,2.47) nd adjustedforageattransplant,racialorigin,primaryrenaldisease,HLAmismatch,andyearoftransplant

A

Overweight nd 17.2 82.8 HR 1.03(0.71,1.49) nd adjustedforageattransplant,racialorigin,primaryrenaldisease,HLAmismatch,andyearoftransplant

Underweight nd 64.4 35.6 HR 1.05(0.70,1.60) nd adjustedforageattransplant,racialorigin,primaryrenaldisease,HLAmismatch,andyearoftransplant

Graftfailure returntodialysisorpreemptiveretransplantation

nd nd ADPKD nd nd nd HR reference reference nd A

CrescenticGN nd nd nd HR 1.53(0.90,2.61) 0.12 adjustedforage,gender,typeoftransplant,ethnicity,donorage,timeondialysispretransplantation,yearoftransplantation,HLAmismatch,andcoldischemictime.HLAmismatchwascategorized(asperNHSBT)into4groupsrangingfromlowtohighlevelsofmismatch:group1,0mismatch;group2,0DRand0/1Bmismatches;group3,0DRand2Bor1DRand0/1Bmismatches;andgroup4,1DRand2Bor2DRmismatches

FSGS nd nd nd HR 2.39(1.78,3.22) <0.0001 adjustedforage,gender,typeoftransplant,ethnicity,donorage,timeondialysispretransplantation,yearoftransplantation,HLAmismatch,andcoldischemictime.HLAmismatchwascategorized(asperNHSBT)into4groupsrangingfromlowtohighlevelsofmismatch:group1,0mismatch;group2,0DRand0/1Bmismatches;group3,0DRand2Bor1DRand0/1Bmismatches;andgroup4,1DRand2Bor2DRmismatches

GNhistologicallynotexamined nd nd nd HR 0.93(0.61,1.41) 0.7 adjustedforage,gender,typeoftransplant,ethnicity,donorage,timeondialysispretransplantation,yearoftransplantation,HLAmismatch,andcoldischemictime.HLAmismatchwascategorized(asperNHSBT)into4groupsrangingfromlowtohighlevelsofmismatch:group1,0mismatch;group2,0DRand0/1Bmismatches;group3,0DRand2Bor1DRand0/1Bmismatches;andgroup4,1DRand2Bor2DRmismatches

GNhistologicallyproven nd nd nd HR 1.68(1.31,2.17) <0.0001 adjustedforage,gender,typeoftransplant,ethnicity,donorage,timeondialysispretransplantation,yearoftransplantation,HLAmismatch,andcoldischemictime.HLAmismatchwascategorized(asperNHSBT)into4groupsrangingfromlowtohighlevelsofmismatch:group1,0mismatch;group2,0DRand0/1Bmismatches;group3,0DRand2Bor1DRand0/1Bmismatches;andgroup4,1DRand2Bor2DRmismatches

IgAnephropthy nd nd nd HR 1.59(1.27,1.99) <0.0001 adjustedforage,gender,typeoftransplant,ethnicity,donorage,timeondialysispretransplantation,yearoftransplantation,HLAmismatch,andcoldischemictime.HLAmismatchwascategorized(asperNHSBT)into4groupsrangingfromlowtohighlevelsofmismatch:group1,0mismatch;group2,0DRand0/1Bmismatches;group3,0DRand2Bor1DRand0/1Bmismatches;andgroup4,1DRand2Bor2DRmismatches

Lupusnephritis nd nd nd HR 1.64(1.13,2.40) 0.01 adjustedforage,gender,typeoftransplant,ethnicity,donorage,timeondialysispretransplantation,yearoftransplantation,HLAmismatch,andcoldischemictime.HLAmismatchwascategorized(asperNHSBT)into4groupsrangingfromlowtohighlevelsofmismatch:group1,0mismatch;group2,0DRand0/1Bmismatches;group3,0DRand2Bor1DRand0/1Bmismatches;andgroup4,1DRand2Bor2DRmismatches


PREDICTORSOFOTHEROUTCOMES27336396 Kang 2016

17198258 Shah 2006

PRE-EMPTIVEvs.EARLYDIALYSIS




%w/opredictor



Notes

Membranousnephropathy nd nd nd HR 1.99(1.38,2.86) 0.0002 adjustedforage,gender,typeoftransplant,ethnicity,donorage,timeondialysispretransplantation,yearoftransplantation,HLAmismatch,andcoldischemictime.HLAmismatchwascategorized(asperNHSBT)into4groupsrangingfromlowtohighlevelsofmismatch:group1,0mismatch;group2,0DRand0/1Bmismatches;group3,0DRand2Bor1DRand0/1Bmismatches;andgroup4,1DRand2Bor2DRmismatches

MPGNtypeII nd nd nd HR 2.33(1.63,3.33) <0.0001 adjustedforage,gender,typeoftransplant,ethnicity,donorage,timeondialysispretransplantation,yearoftransplantation,HLAmismatch,andcoldischemictime.HLAmismatchwascategorized(asperNHSBT)into4groupsrangingfromlowtohighlevelsofmismatch:group1,0mismatch;group2,0DRand0/1Bmismatches;group3,0DRand2Bor1DRand0/1Bmismatches;andgroup4,1DRand2Bor2DRmismatches

MPGNtypeII nd nd nd HR 3.50(1.87,6.55) <0.0001 adjustedforage,gender,typeoftransplant,ethnicity,donorage,timeondialysispretransplantation,yearoftransplantation,HLAmismatch,andcoldischemictime.HLAmismatchwascategorized(asperNHSBT)into4groupsrangingfromlowtohighlevelsofmismatch:group1,0mismatch;group2,0DRand0/1Bmismatches;group3,0DRand2Bor1DRand0/1Bmismatches;andgroup4,1DRand2Bor2DRmismatches

GPA nd nd nd HR 1.16(0.68,1.98) 0.6 adjustedforage,gender,typeoftransplant,ethnicity,donorage,timeondialysispretransplantation,yearoftransplantation,HLAmismatch,andcoldischemictime.HLAmismatchwascategorized(asperNHSBT)into4groupsrangingfromlowtohighlevelsofmismatch:group1,0mismatch;group2,0DRand0/1Bmismatches;group3,0DRand2Bor1DRand0/1Bmismatches;andgroup4,1DRand2Bor2DRmismatches

Preemptivetransplantation nd nd nd HR 0.72(0.53,0.97) 0.03 adjustedforage,gender,typeoftransplant,ethnicity,donorage,timeondialysispretransplantation,yearoftransplantation,HLAmismatch,andcoldischemictime.HLAmismatchwascategorized(asperNHSBT)into4groupsrangingfromlowtohighlevelsofmismatch:group1,0mismatch;group2,0DRand0/1Bmismatches;group3,0DRand2Bor1DRand0/1Bmismatches;andgroup4,1DRand2Bor2DRmismatches

<1yearondialysis nd nd nd HR 1.02(0.82,1.26) 0.9 adjustedforage,gender,typeoftransplant,ethnicity,donorage,timeondialysispretransplantation,yearoftransplantation,HLAmismatch,andcoldischemictime.HLAmismatchwascategorized(asperNHSBT)into4groupsrangingfromlowtohighlevelsofmismatch:group1,0mismatch;group2,0DRand0/1Bmismatches;group3,0DRand2Bor1DRand0/1Bmismatches;andgroup4,1DRand2Bor2DRmismatches

1-3yearsondialysis nd nd nd HR reference reference nd>3yearsondialysis nd nd nd HR 1.41(1.17,1.70) 0.0003 adjustedforage,gender,typeoftransplant,

ethnicity,donorage,timeondialysispretransplantation,yearoftransplantation,HLAmismatch,andcoldischemictime.HLAmismatchwascategorized(asperNHSBT)into4groupsrangingfromlowtohighlevelsofmismatch:group1,0mismatch;group2,0DRand0/1Bmismatches;group3,0DRand2Bor1DRand0/1Bmismatches;andgroup4,1DRand2Bor2DRmismatches

Post-transplantmaliganacyoverall

nd 5-yearspost-Txp:w/pre-Txpcancer31.6%,w/opre-Txpcancer7.4%

5-yearspost-Txp:w/pre-Txpcancer68.4%,w/opre-Txpcancer92.6%

Pre-Txpskincancer(vs.nopre-Txpcancer) nd 1671pt nd HR 2.60(2.27,2.98) <0.001 adjustedforsex,age,ethnicity,hypertension,BMI,inductiontherapy,tacrolimususeatdischarge,HLADR,diabetes,serostatusofCMV,EBV,HBV,HCV,andserumcreatinine

A

Pre-TxpNMSCalone(vs.nopre-Txpcancer) nd 1024pt nd HR 2.89(2.47,3.40) <0.001Pre-Txpmelanomaskincanceralone(vs.nopre-Txpcancer) nd 398pt nd HR 1.77(1.30,2.40) <0.001

New-onsetdiabetesmellitus

nd 12mo8.9%,24mo14.8% 12mo91.1%,24mo85.2%

Age by10years,ascontinuousvariable na na HR 1.29(1.24,1.34) <0.001 sex,race,donor-ECDvsSCD,livingvsdeceased,HLAmismatching,immunosuppressiveRx

A

HTN(yesvs.no) na 77.6 22.4 HR 1.26(1.11,1.44) <0.001BMI25-30(vs.<25) na 32.4 42.5 HR 1.39(1.24,1.57) <0.001BMI>30(vs.<25) na 23.1 HR 1.84(1.63,2.08) <0.001HCVantibody(+vs.-) na 4.2 79.6 HR 1.42(1.15,1.74) 0.001


27653837 Amaral 2016

23371953 Grams 2013




%w/opredictor



Notes

Graftfailure death-censoredgraftfailure,inwhichdeathwithgraftfunctionwastreatedasgraftfailure,andmortality

5years14.6%forpreemptive,23.6%fornon-preemptive

5years85.4%forpreemptive,76.4%fornon-preemptive

Pre-emptiveKTxp(yesvsno) atransplantwithnohistoryofdialysis 13.6 86.4 HR 1.32(1.10,1.56) nd sex,race/ethnicity,ageattimeoftransplantation,etiologyofend-stagerenaldisease,panelreactiveantibody,insurancestatusatthetimeoftransplantation,neighborhoodpoverty,donortype(incombineddonortypemodels),andcoldischemiatime(indeceaseddonorrecipientmodels).

A

Mortailty allcausemortality

4.4% 95.6% Pre-emptiveKTxp(yesvsno) atransplantwithnohistoryofdialysis 13.6 86.4 HR 1.69(1.22,2.33) nd

death nd nd earlydialysisvs.preemptive early:<=1year nd nd HR 1.06(0.99,1.14) 0.06 propensitymatchedonUNOSregion,recipientanddonorage,recipientsex,ethnicity,impairedfunctionalstatus,PRA,HepCstatus,previousnon-kidneytransplant,insurancetype,etiologyofrenaldisease,transplantyear,ECD,DCD,zero-antigenmismatch,coldischemiatime,waittime

B *baselinesestimatedfromtable

death-censoredgraftloss nd nd nd earlydialysisvs.preemptive early:<=1year nd nd HR 1.21(1.12,1.30) <0.001

KDIGO-TransplantCandidateGuidelineTopic:RegistrystudiesQualityassessment


Population:Non-biasedselectionofstudyparticipantswithoutinappropriaterestrictionsorselection.Alleligibleparticipantsincludedorarandomselectionofthese.Nobiasedorlargelosstofollow-up.

Predictors/Variables:Allpredictorsorstudyvariablesarewell-definedandappropriatelymeasured.

Outcome:Clearlylongitudinal(incidentoutcome)[onlyifrelevant].Outcomeblindlyadjudicatedorequivalent.Measuredcompletelyandthesameforallparticipants.

Confounders:Importantpotentialconfoundingfactorsappropriatelyaccountedfor.

24370342 Tancredi 2014 low unclear unclear low23295317 Cannon 2012 low low low low26569067 Naik 2016 low low low low26102616 Opelz 2016 unclear high high low24009216 Kainz 2013 low high low low26660200 Ilori 2015 low low low low26147285 Krishnan 2015 high(exludedallptsw/oBMIdata) low low low27653837 Amaral 2016 low low low low25758804 Pieloch 2015 low low low high(someimportantconfoundersnotadjusted,alsonotreportedasbaseline)21415312 Streja 2011 low low low low25135680 Wightman 2014 low low low low24138318 Farrugia 2014 low low low low27336396 Kang 2016 low unclear unclear low20814353 Huang 2010 low low unclear low26720436 Lynch 2016 high unclear low low20801565 Kasiske 2010 high unclear low low24070588 Pieloch 2014 low low unclear low21566110 Reddy 2011 low/unclear low unclear low21449945 Molnar 2011 low low unclear low17198258 Shah 2006 low unclear unclear low25098499 Xia 2014 low unclear low low21797974 Clayton 2011 low low low low19353768 Mulay 2009 low low low low12110738 Briganti 2002 low low low low3406350 Heaphy 2013 low low low low23371953 Grams 2013 low low low low22124283 Foster 2011 low low low low26636735 Barraclough 2016 low low low low28010785 Lim 2017 low low low low28361229 Ladhani 2017 low low low low26924061 Pruthi 2016 low low unclear low

KDIGO-TransplantCandidateGuidelineTopic:RegistrystudiesQualityassessment


24370342 Tancredi 201423295317 Cannon 201226569067 Naik 201626102616 Opelz 201624009216 Kainz 201326660200 Ilori 201526147285 Krishnan 201527653837 Amaral 201625758804 Pieloch 201521415312 Streja 201125135680 Wightman 201424138318 Farrugia 201427336396 Kang 201620814353 Huang 201026720436 Lynch 201620801565 Kasiske 201024070588 Pieloch 201421566110 Reddy 201121449945 Molnar 201117198258 Shah 200625098499 Xia 201421797974 Clayton 201119353768 Mulay 200912110738 Briganti 20023406350 Heaphy 201323371953 Grams 201322124283 Foster 201126636735 Barraclough 201628010785 Lim 201728361229 Ladhani 201726924061 Pruthi 2016

Model:Multivariable.Allincludedvariablesreported.Appropriatemodelandmethodsforvariableselectionused.Reportedresultsinterpretable.

OVERALL:highifPopulation,Outcome,Modelbiased/bad;maybehighifpredictorsandconfoundersalonearehigh

low lowlow lowlow lowlow highlow lowlow lowhigh(forusinguncertainprimarydiagnosis) highlow lowhigh(someimportantconfoundersnotadjusted,notgavereasons) highlow/high(about50%ptwereexcludedinthemultivariatemodel) highlow/high(about50%ptwereexcludedinthemultivariatemodel) highlow lowlow low/unclearlow lowlow highlow high/unclearlow lowlow lowlow lowlow lowlow lowlow lowlow lowlow lowlow lowunclear lowlow lowlow lowlow lowlow lowlow low

Evidence Profile AA. Pre-Transplant Predictors of Post-Transplant Outcomes Other Than Death and Graft Loss (from Registry Studies)

Outcome Predictor Registries (No.

Studies)

Percent w/Predictor

Methodological Quality of Studies

Consistency Across Studies

Directness of the

Evidence

Other Considerations

Summary of Findings Quality of

Evidence Description of Findings Outcome

Importance Post-transplant malignancy

Pre-txp skin

cancer

UNOS (1)

1.6 No limitations (0)

NA Direct (0)

Sparse (-2)

Low Pre-transplant skin cancer, pre-transplant NMSC, and pre-transplant melanoma were significant predictors of post-transplant malignancy (HR=2.60, 2.89, 1.77)

High

New-onset DM

Age OPTN/UNOS (1)

NA No limitation (0)

NA Direct (0)

Sparse (-2)

Low Increased age, per decade, is significantly associated with new-onset DM (HR=1.29).

Moderate

HTN OPTN/UNOS (1)

77.6 No limitation (0)

NA Direct (0)

Sparse (-2)

Low Hypertension is a statistically significant predictor of new-onset DM (HR=1.26).

BMI OPTN/UNOS (1)

nd No limitation (0)

NA Direct (0)

Sparse (-2)

Low Obesity (BMI 25-30) and morbid obesity (BMI >30) significantly predict new-onset DM (HR=1.39, 1.84)

HCV Antibody

OPTN/UNOS (1)

4.2 No limitation (0)

NA Direct (0)

Sparse (-2)

Low Positive hepatitis C virus antibody is a statistically significant predictor of new-onset DM (HR=1.42).

Overall summary: Sparse data suggest that pre-transplant skin cancers predict post-transplant malignancies, and that

increasing age, hypertension, obesity, and HCV significantly predict new-onset DM after transplantation

Quality of Overall Evidence: Low

Studies included in EP: PMID 27336396; PMID 17198258 Abbreviations: BMI = body mass index, DM = diabetes mellitus, HCV = hepatitis C virus, HR = hazard ratio, nd = no data; NMSC=Non-melanoma skin cancer OPTN = Organ Procurement and Transplantation Network- other names of the database include the Scientific Registry of Transplant Recipients (SRTR) and United Network for Organ Sharing (UNOS)

Evidence Profile AA. Pre-Transplant Predictors of Post-Transplant Mortality (from Registry Studies)* Predictor Registries

(No. Studies) Percent

w/Predictor Methodological

Quality of Studies


Directness of the

Evidence


Summary of Findings Quality of Evidence

Description of Findings Outcome Importance

Elderly (age ≥60 yo)

ANZDATA, OPTN/UNOS,

SRTR†, HES/ONS,

USRDS (5)

≥60 100%;

≥70 yo: 20% in 1

study; ≥65 yo: 9% in 1 study

Serious limitations

(-1)‡

No important inconsistencies

(0)

Direct (0)

None Moderate Among elderly, higher risk with increased age (categorical: HR= 1.42-15.7, HR increased as the age increased; continuous: HR= 1.47)

Critical

Other ages ANZDATA, OPTN/UNOS,

SRTR†, HES/ONS

(4)

Age 45-64 yo: 53% in

1 study

No limitations (0)


(0)

Direct (0)

None High Among patients younger than 60, older age associated with higher risk (categorical: HR= 1.67-3.22, continuous: HR= 1.04)

BMI/Obesity ANZDATA, SRTR†, UNOS

RR/NHSBT (6)

BMI>35: 3.3-20%

Very serious limitations

(-2)§


(0)

Direct (0)

None Low Neither high BMI (HR= 0.48-1.96) nor low BMI (HR= 1.96) is significant associated with poor survival outcome, except for BMI 30-35 vs. <30 Sig (HR= 0.92) associated with better outcome in one study

DM ANZDATA, SRTR†,

HES/ONS, USRDS

(4)

15.2-37.0%

Serious limitations

(-1)‡


(0)

Direct (0)

None Moderate DM consistently associated with higher risk of mortality (HR= 1.39-1.64)

PVD SRTR†, HES/ONS, OEDTR, USRDS

(4)

0.7-13% Very serious limitations

(-2)#


(0)

Indirect (-1)#

None Very low PVD consistently associated with higher risk of mortality (HR= 1.15-4.60)

CVD (including AMI and CAD)

ANZDATA, SRTR†,

HES/ONS, USRDS

(4)

2.4-7.0% Serious limitations

(-1)‡


(0)

Direct (0)

None Moderate CVD consistently associated with higher risk of mortality (HR= 1.16-1.52)

CHF HES/ONS, USRDS

(2)

0.6-12.7% Very serious limitations

(-2)#

Important inconsistencies

(-1)

Indirect (-1)#

None Very low Unclear: association between CHF and mortality significant in one study (HR= 1.22), NS in one (HR= 1.51); LAD as continuous variable, Sig, HR= 1.06; RLD as continuous variable, NS, HR= 0.95

Predictor Registries (No. Studies)

Percent w/Predictor



Directness of the

Evidence




GN UKRR/NHS Blood and Transplant

(1)

nd No limitations (0)

N/A Direct (0)

Sparse (-1)

Moderate Lupus nephritis (HR = 1.81, p=0.013) and MPGN type II (HR = 4.68, p=0.0003) had a greater reduction in 10-year patient survival than APKD. DM types I and II (HR=2.24, 1.59, p=<0.0001, 0.001) and other or not reported kidney disease (HR = 1.28, 1.28, p= 0.007, 0.004) had higher risk of mortality than GN. Polycystic kidney disease had no significant difference (HR=0.81, p=0.56).

Time on dialysis

UKRR (1)


N/A Direct (0)

Sparse (-1)

Moderate Over 3 years on dialysis (HR=1.57, p<0.0001) significantly reduced 10-year patients survival, while less than 1 year on dialysis (HR=0.68, p-0.01) significantly improved 10-year patient survival compared to 1-3 years on dialysis.

Overall summary: Older age, DM, CVD, GN, and time on dialysis are associated with higher risk of death.

Higher BMI and obesity may not be associated with higher risk of death. For other predictors, the evidence was unclear or there was insufficient evidence.*

Quality of Overall Evidence: Moderate

Low Very Low

Studies included in EP: PMID 23295317; PMID 24138318; PMID 20814353; PMID 26660200; PMID 24009216; PMID 27336396; PMID 26147285; PMID 26720436; PMID 21449945; PMID 27391198; PMID 22156753; PMID 26102616; PMID 24070588; PMID 25758804; PMID 21566110; PMID 21415312; PMID 25135680; PMID 25098499; PMID 26636735; PMID 28010785; PMID 28361229; PMID 26924061 Abbreviations: N/A= Not available or not applicable, BMI= Body mass index, DM= Diabetes mellitus, PVD= periphervascular disease, CVD= Cardiovascular disease, AMI= Acute myocardial infarction, CAD= Coronary artery disease, CHF= Chronic heart failure, LAD= Left atrium diameter, RVD= Right ventricle diameter, OPTN = Organ Procurement and Transplantation Network- other names of the database include the Scientific Registry of Transplant Recipients (SRTR) and United Network for Organ Sharing (UNOS), DaVita = Kidney disease and dialysis information, USRDS = The United States Renal Data System, ANZDATA = The Australian and New Zealand Dialysis and Transplantation Registry, OEDTR = Österreichische Gesellschaft für Nephrologie, CTS = Collaborative Transplant Study, HES = Hospital Episode Statistics, ONS = Office for National Statistics, RR = the UK Renal Registry, NHSBT = the National Health Service Blood and Transplant, UKRR = United Kingdom Renal Registry, MPGN = membranoproliferative glomerulonephritis, APKD = adult polycystic kidney disease * See list of predictors evaluated by a single study each below the footnotes. † Linked with DaVita. ‡ Biased selection of patient population in one study. § Biased selection of patient population in one study. Some important confounders not adjusted and no reasoning described for the selection of co-variates in one study. Approximately 50% patients

were excluded in the multivariate analysis due to the lack of data in one study. # No specific definition or diagnostic criteria provided for the predictor in one study. Only one study for each of the following predictors:

• Albumin, by 0.2 g/dl DaVita/ SRTR HR= 0.87 (0.82, 0.93) • Albumin, by 1 g/dl DaVita/ SRTR HR= 0.62 (0.52, 0.75) • Cerebral vascular accident, presence (vs. absence) HES/ONS HR= 1.66 (0.91, 3.03) • COPD, presence vs. absence USRDS HR= 1.20 (1.02, 1.41) • Creatinine, by 1 mg/dl SRTR/MHD HR= 0.91 (0.86, 0.95) • Current smoker, vs. never smoker CTS HR= 1.6 (1.5, 1.8) • Definite intellectual disability, presence vs. absence UNOS HR= 0.3 (0.2, 12.2) • Diabetic nephropathy, presence (vs. absence) UNOS HR= 1.61 (1.50, 1.73) • Dialysis modality, peritoneal dialysis (vs. hemodialysis) DaVita/ SRTR HR= 0.57 (0.38, 0.87) • Ever smoker, vs. never smoker CTS HR= 1.1 (1.0, 1.2) • Hepatitis B infection, HBV + (vs. HBV -) OPTN/UNOS HR= 0.98 (0.59, 1.63) (in recipients of living donors), 1.09 (0.88, 1.36) (in recipients of deceased donors) • HIV infection, HIV + (vs. HIV -) SRTR/OPTN HR= 1.25 (0.61, 2.56) • Hypertensive nephropathy, presence (vs. absence) UNOS HR= 1.10 (1.02, 1.19) • Kidney transplant morbidity index score, score 1, score 2, score 3, score 4, score 5, score 6, score 7 (vs. score 0) OPTN/UNOS HR= 1.85 (1.45, 2.36), 3.11 (2.46, 3.94),

5.00 (3.96, 6.31), 7.37 (5.83, 9.32), 9.41 (7.41, 11.94), 12.51 (9.45, 15.63), 13.03 (9.68, 17.54) • Pre-transplant skin cancer excluding patients with solid cancers, vs. no pre-transplant skin cancer UNOS HR= 1.17 (1.04, 1.32) • Pre-transplant skin cancer, vs. no pre-transplant skin cancer UNOS HR= 1.20 (1.07, 1.34) • Probable intellectual disability, presence vs. absence UNOS HR= 0.2 (0.1, 1.3) • Socioeconomic deprivation, score 2, score 3, score 4 (vs. score 1) HES/ONS HR= 0.84 (0.68, 1.05), 0.86 (0.69, 1.08), 0.86 (0.68, 1.08)

Evidence Profile AA. Effect of pre-emptive transplantation on post-transplant outcomes (from registry studies)

Outcome Registries (No.

Studies)

Total N of Patients



Directness of the

Evidence




Death-censored graft loss

SRTR, USRDS

(2)

26503 No limitations (0)


(-2)*

Direct (0)

Sparse (-1)

Very low Lower risk c/t transplant w/in 1 y (HR ~0.94†) but higher c/t all post-dialysis transplants (HR=1.69)

Critical

Death SRTR, USRDS

(2)

26503 No limitations (0)


(-2)*

Direct (0)

Sparse (-1)

Very low Lower risk c/t transplant w/in 1 y (HR ~0.83†) but higher c/t all post-dialysis transplants (HR=1.32)

Critical

Overall summary: Unclear whether pre-emptive transplantation lowers risk of graft loss or death.

Quality of Overall Evidence: Very Low

Studies included in EP: PMID 27653837; PMID 23371953 Abbreviations: SRTR = Scientific Registry of Transplant Recipients, USRDS = United States Renal Data System * One study compared pre-emptive transplant with transplant within 1 year of starting dialysis, while the other compared pre-emptive transplant vs. transplant any time after start of dialysis. These studies had different findings. † Inverse of reported hazard ratio

Evidence Profile AA. Pre-Transplant Predictors of Graft Loss (from Registry Studies)* Predictor

(Suboutcome) Registries

(No. Studies) Percent

w/Predictor Methodological

Quality of Studies


Directness of the

Evidence




Elderly ANZDATA, SRTR†,

OPTN/UNOS (4)

≥60 100%; ≥70 20%

No limitations (0)


(0)

Direct (0)

Sparse (-2)

Low Among elderly, no difference by age (categorical), although one continuous analysis found lower risk with increasing age

Critical

Other ages ANZDATA, SRTR†, USRDS

(3)



(-1)

Direct (0)

Sparse (-2)

Very low Unclear: Risk of graft loss varies by age, but pattern is not consistent across studies

(2ary GN recurrence)

USRDS, ANZDATA

(2)

N/A No limitations (0)


(-1)

Direct (0)

Sparse (-2)

Very low Unclear: Risk of graft loss due to GN recurrence decreases with higher age in one study (HR=0.86 per decade), but no significant association in another study

Albumin SRTR†, OPTN (2)

Low albumin:

28% in one study

No limitations (0)


(-1)

Direct (0)

Sparse (-2)

Very low Hypoalbuminemia is significantly associated with increased graft loss (HR 1.36-1.71), but one study found NS association when evaluated as a continuous variable.

BMI/Obesity ANZDATA, OPTN/UNOS,

SRTR†, USRDS

(7)

Obesity/overweight: 2-

64%

Serious limitations

(-1)‡


(0)

Direct (0)

None (0)

Moderate Morbid obesity (BMI ≥40) associated with higher graft loss (HR =1.13-1.26); other evaluations of BMI (including underweight) NS

DM as cause of ESRD

ANZDATA, SRTR†, USRDS

(3)

37% in one study

No limitations (0)


(-1)

Direct (0)

Sparse (-2)

Very Low Unclear: One study each found significant and NS associations

GN as cause of ESRD

ANZDATA, OPTN/USRDS

, SRTR†, UKRR, USRDS

(6)


(-1)§


(-1)

Direct (0)

Sparse (-2)

Very low Unclear: One study each found lower, no, or higher risk of graft loss

Membranous GN as cause of ESRD (2ary GN recurrence)

ANZDATA, UKRR, USRDS

(3)

20.6% in one study

No limitations (0)


(-1)

Direct (0)

Sparse (-2)

Very Low Unclear: One study each found significant and NS associations.

Predictor (Suboutcome)

Registries (No. Studies)

Percent w/Predictor



Directness of the

Evidence




FSGS as cause of ESRD (2ary GN recurrence)

USRDS, ANZDATA

(2)

20.6% in one study

No limitations (0)


(0)

Direct (0)

Sparse (-2)

Low Risk of graft loss due to GN recurrence is associated with FSGS as the primary cause of ESRD (HR=1.53, 2.03).

IgA nephropathy as cause of ESRD (2ary GN recurrence)

UKRR, USRDS,

ANZDATA (3)

6.6% in one study

No limitations (0)


(-1)

Direct (0)

Sparse (-2)

Very Low Unclear: One study each found significant and NS associations.

HTN as cause of ESRD

OPTN/USRDS, SRTR†, UNOS

(3)


(-1) §


(-1)

Direct (0)

Sparse (-2)

Very low Unclear: One study each found lower, no, or higher risk of graft loss.

Cystic disease as cause of ESRD

OPTN/USRDS, SRTR†

(2)


(-1)§


(-1)

Direct (0)

Sparse (-2)

Very low Unclear: One study each found significant and NS associations.

PRA (2ary GN recurrence)

ANZDATA, USRDS, SRTR†

(2)

2.4-15.9% No limitations (0)


(-1)

Direct (0)

Sparse (-2)

Very Low Unclear: One continuous analysis found increased risk of graft loss due to GN recurrence per 10% increment, but another found no significant association as a categorical variable (>50% vs. <50%).

Dialysis duration (2ary GN recurrence)

ANZDATA, USRDS, UKRR

(5)

26.2-71.3% No limitations (0)


(0)

Direct (0)

None (0)

High Per 1-y increment, NS; 1-12 months vs. 0 months, HR=2.08, sig, 12-36 months vs. 0 months, HR=1.71, sig; >36 months vs. 0 months, HR=1.26, NS; >36 months vs. 12-36 months HR=1.41, sig

Primary kidney diagnosis

UKRR (1)

nd Serious limitations

(-1)**

N/A Direct (0)

Sparse (-2)

Very Low FSGS (HR=2.39, p<0.0001), GN histologically proven (HR=1.68, p<0.0001), IgA nephropathy (HR=1.59, p<0.0001), lupus nephritis (HR = 1.64, p=0.01), membranous nephropathy (HR=1.99, p-0.0002), MPGN type I (HR=2.33, p<0.0001) and MPGN type II (HR = 3.50, p<0.0001) had a greater reduction in 10-year graft loss than APKD.

Predictor (Suboutcome)

Registries (No. Studies)

Percent w/Predictor



Directness of the

Evidence




Overall summary: Dialysis duration is a predictor of graft loss due to GN recurrence.

Morbid obesity (BMI ≥40 kg/m2) is a predictor of graft loss. Among elderly, older age may not be a predictor of graft loss. FSGS may be a predictor of graft loss due to GN recurrence.

For other predictors, the evidence was unclear or there was insufficient evidence.*

Quality of Overall Evidence: High

Moderate Low Low

Very Low Studies included in EP: PMID 24370342; PMID 12110738; PMID 23295317; PMID 21797974; PMID 22124283; PMID 23406350; PMID 20814353; PMID 26660200; PMID 24009216; PMID 27336396; PMID 20801565; PMID 21449945; PMID 27391198; PMID 22156753; PMID 19353768; PMID 26569067; PMID 26102616; PMID 24070588; PMID 25758804; PMID 21566110; PMID 21415312; PMID 25135680; PMID 25098499; PMID 26636735; PMID 28361229; PMID 26924061 Abbreviations: N/A= Not available or not applicable, BMI= body mass index, NS= non-significant, Sig= significant, ESRD= end-stage kidney disease, HR= hazard ratio, CAKUT= congenital anomalies of the kidney and the urinary tract, GN= glomerulonephritis, DM= diabetes mellitus, HTN= hypertension, OPTN = Organ Procurement and Transplantation Network- other names of the database include the Scientific Registry of Transplant Recipients (SRTR) and United Network for Organ Sharing (UNOS), DaVita = Kidney disease and dialysis information, USRDS = The United States Renal Data System, ANZDATA = The Australian and New Zealand Dialysis and Transplantation Registry, UKRR = United Kingdom Renal Registry, MPGN = membranoproliferative glomerulonephritis, APKD = adult polycystic kidney disease, FSGS = focal segmental glomerulosclerosis, GN = glomerulonephritis * See list of predictors evaluated by a single study each below the footnotes. † Linked with DaVita ‡ Approximately 50% patients were excluded in the multivariate analysis in one study due to missing data. Important confounders were not adjusted for with no further explanations in another study. § Biased selection of patient population in one study. ** Database poorly described. Only one study for each of the following predictors: Outcome = Graft loss (all cause)

• Cerebrovascular disease, presence (vs. absence) OEDTR HR= 2.52 (0.61, 10.36) • Coronary heart disease, presence (vs. absence) OEDTR HR= 0.60 (0.18, 1.99) • Creatinine, per I mg/dl SRTR/MHD HR= 0.96 (0.81, 1.00) • Current smoker, vs. never smoker CTS HR= 1.5 (1.4, 1.6) • Diabetes mellitus, presence (vs. absence) SRTR/DaVita HR= 1.35 (1.14, 1.61) • Dialysis duration, per 1 year USRDS HR= 1.02 (1.01, 1.02) • Dialysis modality, peritoneal dialysis (vs. hemodialysis) SRTR/DaVita HR= 1.08 (0.79, 1.47) • Former smoker, vs. never smoker CTS HR= 1.1 (1.0, 1.1) • FSGS as cause of ESRD, FSGS (vs. congenital anomalies of the kidneys or urinary tract) USRDS HR= 1.13 (1.07, 1.20) • Hepatitis B infection, HBV + (vs. HBV -) OPTN/UNOS HR= 0.74 (0.45, 1.24) (in recipients of living donors), 1.06 (0.85, 1.33) (in recipients of deceased donors) • HIV infection, HIV + (vs. HIV -) SRTR/OPTN HR= 1.18 (0.66, 2.08) • Intellectual disability, definite intellectual disability, probable intellectual disability (vs. no intellectual disability) UNOS HR= 1.1 (0.5, 2.5), 0.5 (0.3, 2.0) • Kidney transplant morbidity index, score 1, score 2, score 3, score 4, score 5, score 6, score 7 (vs. score 0) OPTN/UNOS HR= 1.30 (1.16, 1.45), 1.44 (1.29, 1.60),

1.74 (1.56, 1.94), 2.08 (1.87, 2.33), 2.46 (2.19, 2.77), 2.97 (2.58, 3.41), 3.11 (2.55, 3.80) • Level of education, High school education, some college or bachelor degree, graduate degree (vs. none/grade school) SRTR HR= 1.09 (1.04, 1.14), 0.96 (0.92, 1.01),

0.95 (0.89, 1.02) • Penal reactive antibody (PRA), PRA 1-30%, 31-80%, >=81% (vs. 0%) SRTR HR= 1.04 (1.00, 1.07), 1.14 (1.09, 1.21), 1.21 (1.12, 1.31)

• Periphervascular disease, presence (vs. absence) OEDTR HR= 2.29 (0.97, 5.41) • Polycystic kidney disease, presence (vs. absence) SRTR HR= 0.75 (0.72, 0.78) • Pre-transplant cancer, pre-transplant skin cancer (vs. no pre-transplant skin cancer) UNOS HR= 1.14 (1.02, 1.27) • Right atrial diameter, per mm OEDTR HR= 1.04 (1.02, 1.07) • Socioeconomic status (SES), SES low-mid quartile, high-mid quartile, highest quartile (vs. lowest quartile) USRDS HR= 0.95 (0.91, 0.98), 0.91 (0.88, 0.94), 0.83 (0.80,

0.86) • Young age (pediatric), age 0-4, age 5-9, age 10-12, age age 13-16 (vs. age 25-29) USRDS HR= 0.94 (0.79, 1.13), 0.60 (0.53, 0.68), 0.56 (0.49, 0.64), 0.91 (0.84, 0.98)

Outcome = Graft loss secondary to GN recurrence • Era (2001-2003 vs. 1990-1994) USRDS 0.39 (0.24, 0.64) • Lupus nephritis as cause of ESRD (vs. other) USRDS HR=0.72 (0.49, 1.06) • Mesangiocapillary glomerulonephritis type I as cause of ESRD (vs. mean risk for all categories of GN) ANZDATA HR=2.91 (1.53, 5.55) • MPGN as cause of ESRD (vs. other) USRDS HR=2.57 (1.84, 3.58) • Pauci-immune crescentic glomerulonephritis as cause of ESRD (vs. mean risk for all categories of GN) ANZDATA HR=nd, NS • Unspecified pathology of ESRD (vs. other) USRDS HR=0.59 (0.44, 0.78) • “Other” pathology of ESRD (vs. mean risk for all categories of GN) ANZDATA HR=0.30 (0.13, 0.66)

Outcome = Graft loss secondary to IgAN recurrence • Age (10y increment) ANZDATA HR=0.87 (0.67, 1.13) • Dialysis duration, 6 months to <1y vs. <6 months, 1y to 5 years vs. <6 months, ≥5 years vs. <6 months ANZDATA HR= 0.73 (0.35, 1.49), 0.50 (0.25, 0.98), 0.40 (0.09, 1.74) • Era (1998-2007 vs. 1988-1992) ANZDATA HR=0.26 (0.10, 0.66)

KDIGO-TransplantCandidate

GuidelineTopic:KTxpvsWL

Categoricaloutcomes

15857921 Oniscu 2005 ScottishRenalRegistryandUKTransplant Retrospective Scotland 1989-1999 1year 1736 Txpvs.WL dialysisandwaitlisted nd 46.6(14.1) 61 nd nd nd nd nd nd nd 26 87 15 Interstitialnephritis30%,multisystem15%

Allcausemortality

17452897 Rao 2007 OrganProcurementandTransplantationNetwork Retrospective US 1990-2004 nd 5667 Txpvs.WL ptwhostarteddialysisbeforeKTxp age>=70 70-7479.0%,>=7521.0% 68 70 16 5 8 NativeAmerican0.5% nd nd 12 30 22 nd,30% Allcausemortality

15031354 Oniscu 2004 nd(sociodemographic,listing,transplantandcomorbiditydatapartlyfromnationalrenal(ScottishRenalRegistry)andtransplant(UnitedKingdomTransplant)databases)

Retrospective Scotland 1989-1999 >1year 325 Txpvs.WL ondialysiswhenwaitlisted >60yo median(IQR)WL66.3(63.0,72.9),Txp64.0(58.5,69.5)

62 nd nd nd nd nd median(IQR)529days(181,877)

median(IQR)252.5days(21,484)

24 nd 10 interstitialnephritis24%,multisystem22%

Allcausemortality

10755528 Johnson 2000 nd(Queenslandcadavericrenaltransplantwaitinglist)

Retrospective Australia 1993-1997 2.8years 174 Txpvs.WL nd >60yo 66.1(0.5) 44 89 nd nd nd nd nd nd 5 nd 10 analgesicnephopathy21%,ADPKD14%,FSGS4%,IgAN6%,idiopathic18%

Allcausemortality

20038521 Heldal 2010 NorwayRenalRegistry Retrospective Norway 1990-2005 nd(tillMay2008) 286 Txpvs.WL ondialysiswhenwaitlisted,firstTxp >=70yo median(range)73.6(70.0,81.0)

70 nd nd nd nd n nd nd 31 nd 4 pyelonephritis10%,hereditaryrenaldisease9%,vasculardiseases38%,other/unknown8%

Allcausemortality

18808405 Gillen 2008 USRDS Retrospective US 1990-2003 nd(tillDec2003) 5961 Txpvs.WL ondialysisatentryofthestudy,firstTxp,nocombinedTxp

<=18yo 11.2(5.1) 57 67 26 nd nd nd,7% nd 7.9months(11.8) 37 nd nd congenital34%,vascular/interstitial7%,nephrotoxic/tumorrelated1%,other7%,unknown13%

Allcausemortality

26765937 Roland 2016 nd(nationalregistrydatabase) Retrospective US 2003-2010 4.0years 317 Txpvs.WL nd HIV+ median(IQR):candidates45(39-52)

84 25 68 nd nd nd nd nd focalGN:4 23 diabeticnephtropathy:11

nd Survival

12631130 Glanton 2003 USRDS Retrospective US 1995-1999 51months(accrual),29months(additional)

7443 Txp(livinganddeceaseddonorsrespectively)vs.WL

ptwhostartedESRDRx,excludedtransplantwithoutprocedingdialysis

excludedotherorganTxp

48.1(12.0) 54 nd 35 nd nd nd nd nd 24 18 40 nd Allcausemortality

Graftloss

Primaryrenal

diagnosis:

HTN,%

Primaryrenal

diagnosis:DM,

%

Primaryrenaldiagnosis:Other,

%

OutcomeRace,

Hispanic,%

Race,Other,% Timeonwaitlist:

WLgroup

Timeonwaitlist:

KTxpgroup

Primaryrenal

diagnosis:GN,

%

Pubmedid Authors Year Nameofdatabase Studydesign Country Periodofpatient

recruitment

Lengthoffollow-up Nanalyzed Inclusioncriteria:

General

Race,

Black,%

Race,

Asian,%

Inclusioncriteria:CKDspecific Inclusion

criteria:Other

Ageatevaluation/listing Sex,male,% Race,

White,%


GuidelineTopic:KTxpvsWL

Categoricaloutcomes

15857921 Oniscu 2005

17452897 Rao 2007

15031354 Oniscu 2004

10755528 Johnson 2000

20038521 Heldal 2010

18808405 Gillen 2008

26765937 Roland 2016

12631130 Glanton 2003


Adjustment,Other

covariates

Pvalue Metrics Comparisoninpredictorgroup Estimateinpredictor

group,mean(95%CI)

Pvaluein

predictorgroup

Adjustmentinpredictorgroup,Other

covariates

Comparisoninnon-predictorgroup Estimateinnon-predictor

group,mean(95%CI)

Pvalueinnon-

predictorgroup

Adjustmentinnon-predictorgroup,

Othercovariates

nd age 18-34 N/A N/A RR KTxpvs.WL 0.23(0.05,1.14) nd age,gender,primaryrenaldisease,

socialdeprivation,timesincewait-

listing,andcomorbidity

nd nd nd nd A

age 35-49 N/A N/A RR KTxpvs.WL 0.26(0.11,0.57) nd nd nd nd nd



age >65 N/A N/A RR KTxpvs.WL 0.34(0.14,0.83) nd nd nd nd nd

nd Elderly(age) >=70 N/A N/A RR KTxpvs.WL 0.59(0.53,0.65) <0.0001 causesofESRD,WLtime nd nd nd nd A

Elderly(age) 70-74 N/A N/A RR KTxpvs.WL 0.58(0.52,0.65) <0.0001 nd nd nd nd

Elderly(age) >=75 N/A N/A RR KTxpvs.WL 0.67(0.53,0.86) <0.05 nd nd nd nd

nd Elderly(age) age>60 N/A N/A RR KTxpvs.WL 0.35(0.22,0.54) nd sex,age,socialdeprivation,primary

renaldisease,dialysismodality,

distancefrompts'hometotheTxp

center

nd nd nd nd A

nd Elderly(age) age>60 N/A N/A HR KTxpvs.WL 0.16(0.06,0.42) nd nd nd nd nd nd B

nd Elderly(age) age>=70 N/A N/A HR KTxpvs.WL 0.78(0.52,1.18)

(subgroups:startingdialysis

1990-1999:1.01(0.58,

1.75);startingdialysisafter

2000:0.40(0.19,0.83))

0.25(starting

dialysis1990-

1999:nd;starting

dialysisafter

2000:0.014)

age,sex,primarykidneydisease,type

ofcenterwheredialysiswasinitiated

(universityvsnotuniversityhospital),

timeondialysisbeforewaitlistingand

dialysismodality

nd nd nd nd A

nd Pediatric(age) age=0-5yo N/A N/A RR KTxpvs.WL 0.76(0.32,1.79)(12-18

monthsf/u);0.52(0.14,

1.91)(30-36monthsf/u)

nd age,sex,race,causeofESRD,timeof

placementonwl

nd nd nd nd A

Pediatric(age) age=6-12yo N/A N/A RR KTxpvs.WL 0.29(0.08,1.03)(12-18

monthsf/u);0.09(0.02,

0.54)(30-36monthsf/u)

nd nd nd nd nd

Pediatric(age) age=13-18yo N/A N/A RR KTxpvs.WL 0.36(0.19,0.69)(12-18

monthsf/u);0.30(0.15,

0.62)(30-36monthsf/u)

nd nd nd nd nd

nd transplantatio

ninHIV+

candidates

receivingtransplantversus

remainingonwaitlist

age(bydecade),BMI

atenrollment(<21)

0.23 HR KTxpvs.WL 0.6(95%CI0.3,1.4) nd nd nd nd nd nd B

nd obesity BMI>=30 N/A N/A HR Obese:KTxp(deceaseddonor)vs.WL 0.39(0.33,0.47) <0.0001 factorsassociatedwithobesityin

patientsplacedontherenaltransplant

waitinglist:race,age,gender,yearof

firstdialysissession,causeofESRD,

additionalvariables

Non-Obese:KTxp(deceaseddonor)vs.

WL

0.39(0.35,0.43) <0.0001 factorsassociatedwithobesityin

patientsplacedontherenaltransplant

waitinglist:race,age,gender,yearof

firstdialysissession,causeofESRD,

additionalvariables

A

obesity BMI>=30 N/A N/A HR Obese:KTxp(livingdonor)vs.WL 0.23(0.16,0.34) <0.0001 Non-obese:KTxp(livingdonor)vs.WL nd nd

obesity BMI>=41 N/A N/A HR Obese:KTxpvs.WL(all) 0.47(0.17,1.25) 0.13 nd nd nd

nd obesity BMI>=30 N/A N/A HR Obese:KTxp(deceaseddonor)vs.WL 0.35(0.29,0.42) <0.0001 Non-Obese:KTxp(deceaseddonor)vs.

WL

0.33(0.30,0.37) <0.0001

Overall

Quality

Predictor Predictordefinition Fullmodel(Txpvs.WLwithinteractionterm) Subgroupmodel1(Txpvs.WLinpredictorsubgroups)Outcome

definition

KDIGO-TransplantCandidateGuidelineTopic:KTxpvsWLQualityAssessment


Population:Non-biasedselectionofstudyparticipantswithoutinappropriaterestrictionsorselection.Alleligibleparticipantsincludedorarandomselectionofthese.Nobiasedorlargelosstofollow-up.

Predictors/Variables:Allpredictorsorstudyvariablesarewell-definedandappropriatelymeasured.

Outcome:Clearlylongitudinal(incidentoutcome)[onlyifrelevant].Outcomeblindlyadjudicatedorequivalent.Measuredcompletelyandthesameforallparticipants.

Confounders:Importantpotentialconfoundingfactorsappropriatelyaccountedfor.

15857921 Oniscu 2005 low low unclear low

17452897 Rao 2007 low low unclear low

15031354 Oniscu 2004 low low unclear low10755528 Johnson 2000 low low unclear unclear20038521 Heldal 2010 low low unclear low18808405 Gillen 2008 low low unclear low12631130 Glanton 2003 low low unclear low26765937 Roland 2016 low low unclear unclear

KDIGO-TransplantCandidateGuidelineTopic:KTxpvsWLQualityAssessment


15857921 Oniscu 200517452897 Rao 200715031354 Oniscu 200410755528 Johnson 200020038521 Heldal 201018808405 Gillen 200812631130 Glanton 200326765937 Roland 2016

Model:Multivariable.Allincludedvariablesreported.Appropriatemodelandmethodsforvariableselectionused.Reportedresultsinterpretable.

OVERALL:highifPopulation,Outcome,Modelbiased/bad;maybehighifpredictorsandconfoundersalonearehigh

low lowlow low

low lowlow unclearlow lowlow lowlow lowlow unclear

Evidence Profile BB. Kidney transplant vs. waitlist. Predictor Outcome # of

Studies

Total N of Patients



Directness of the

Evidence




Age Death 6 14149 (174-5961)

No limitations (0)


(0)

Direct (0)

None (0)

High Txp superior to waitlist in almost all age groups*†

Critical

Transplantation in HIV+

Death 1 317 Serious limitations

(-1)

N/A Direct (0)

Sparse (-2)

Very Low Txp was comparable to waitlist in patients who were HIV+

Obesity Death 1 7443 No limitations (0)

N/A Direct (0)

Sparse (-2)

Low Txp similarly superior to waitlist among obese and nonobese

Graft loss

1 7443 No limitations (0)

N/A Direct (0)

Sparse (-2)

Low Txp similarly superior to waitlist among obese and nonobese

Critical

Overall summary: Transplant generally found to be superior to continued waitlist status regardless of age or obesity

Quality of Overall Evidence: Variable

Studies included in EP: PMID 15857921; PMID 17452897; PMID 15031354; PMID 10755528; PMID 20038521; PMID 18808405; PMID 26765937; PMID 12631130 Abbreviations: GL = Guideline, N/A = not applicable, NS = nonsignificant predictor, Txp = transplantation. * 1 study found similar RR (0.12-0.34) of transplant vs. waitlist across age groups 18-34 years through >65 years (lowest age cohort was non-significant, likely due to lack of statistical power). 4 studies restricted to elderly (>60-70 years) all found significantly lower death with transplant (RR/HR=0.36-0.67), including in a subgroup restricted to ≥75 years old. 1 study of children found large differences in death, favoring transplant over waitlist across 3 age strata (0-5, 6-12, 13-18 years; HR=0.09-0.52); however, in the small subset of 0/5 year olds, the RR was not statistically significant.

KDIGO-PsychosocialGuidelineTopic:PsychosocialCategoricaloutcomes

PMID Author Year Typeofarticle CountryEra(Studyyears)

Studydesign PopulationAge[mean{SD}ormedian(range)]

%MaleBaselineCKDstage

Baselinekidneyfunction

Subgroup

26517474 Maldonado 2015 Peer-reviewarticle US 2008-2011(yearofTxp) Retrospectivecohortstudy ALLTRANSPLANTPATIENTS-36heart,68lung,58liver,55

52{13.4}inallTxppt 60%inallTxppt nd nd SIPAT-Excellent

SIPAT-Good

SIPAT-Minimallyacceptabletohighriskscore

SIPAT-Excellent

SIPAT-Good


SIPAT-Excellent

SIPAT-Good


KIDNEYTRANSPLANTONLY 46.6{14.7}inKTxppt 60%inKTxppt nd nd Overall

Overall

Overall

21620037 Calia 2011 peer-reviewedpublication Italy nd prospectivecohort KTC 42.3 48.5 nd nd Psychoticism

KDIGO-PsychosocialGuidelineTopic:PsychosocialCategoricaloutcomes

PMID Author Year

26517474 Maldonado 2015

21620037 Calia 2011

Test Subgroupdescription Outcome DefinitionOutcomemeasurementtimepoint

Samplesize(N)Frequency(event)rate,%

Relativeeffect Pvalue Overallquality

StanfordIntegratedPsychosocial

AssessmentforTransplantation

SIPATscore=0-6 Mortailty nd 1ypost-Txp 54 (5)9.3% HR0.98(0.92,1.06) 0.652 B

SIPATscore=7-20 127 (18)14.2%

SIPATscore>=21 36 (3)8.3%

SIPATscore=0-6 Organfailure nd 54 (3)5.6% HR0.99(0.96,1.04) 0.803

SIPATscore=7-20 127 (8)6.3%

SIPATscore>=21 36 (1)2.8%

SIPATscore=0-6 Nonadherence nd 54 (6)11.5% AUC0.60(0.50,0.71) 0.058

SIPATscore=7-20 127 (20)15.9%

SIPATscore>=21 36 (10)27.8%

SIPATscoreany Mortailty 1ypost-Txp 55 0.0%

SIPATscoreany Organfailure 55 0.0%

SIPATscoreany Nonadherence 55 (12)22.2%

Eysenck Personality Questionnaire [other tests (Fear Invetory, MOCQ-R, STAI) and other items in EPQ were not associated with graft failure]

medianscore:w/graftfailure3.5±1.6vs.w/ograftfailure2.3±1.3

Higherscoresonthepsychoticismfactorsuggestedsolitudeand

difficultyadaptingtotheexternalenvironment.

Graftfailure nd nd 33 10(30.3%) nd nd B

CBA-2,0“PrimaryScale"includesEPC,Fear

Invetory,MOCQ-R,STAI

nd Graftrejection nd nd 33 nd OR2.088(1.083,1.025) 0.028

KDIGO-TransplantCandidateGuidelineTopic:PsychosocialQualityAssessment

RCT:Adequategenerationofarandomizedsequence RCT:.....Allocationconcealment RCT:.....BlindingofPATIENTS RCT:.....BlindingofPROVIDERS RCT.....Intention-to-treat-analysis NonRCT…..Representativenessofthecase? NonRCT…..Selectionoftheexposedcohort

PMID Author Year

Thereisalowriskofselectionbiasiftheinvestigatorsdescribearandomcomponentinthesequencegenerationprocesssuch

as:referringtoarandomnumbertable,usingacomputerrandomnumbergenerator,cointossing,shufflingcardsorenvelopes,throwingdice,drawingoflots,minimization(minimizationmaybeimplementedwithoutarandomelement,andthisisconsideredtobeequivalenttobeing

random).Thereisahighriskofselectionbiasiftheinvestigatorsdescribeanon-randomcomponentinthe

sequencegenerationprocess,suchas:sequencegeneratedbyoddorevendateofbirth,date(orday)ofadmission,hospitalorclinicrecordnumber;orallocationbyjudgementofthe

clinician,preferenceoftheparticipant,resultsofalaboratorytestoraseriesoftests,oravailabilityoftheintervention.

Thereisalowriskofselectionbiasiftheparticipantsandinvestigatorsenrollingparticipantscouldnotforesee

assignmentbecauseoneofthefollowing,oranequivalentmethod,wasusedtoconcealallocation:centralallocation(includingtelephone,web-basedandpharmacy-controlledrandomization);sequentiallynumbereddrugcontainersofidenticalappearance;orsequentiallynumbered,opaque,

sealedenvelopes.Thereisahighriskofbiasifparticipantsorinvestigatorsenrollingparticipantscouldpossiblyforeseeassignmentsandthusintroduceselectionbias,suchas

allocationbasedon:usinganopenrandomallocationschedule(e.g.alistofrandomnumbers);assignmentenvelopeswereusedwithoutappropriatesafeguards(e.g.ifenvelopeswereunsealedornon-opaqueornotsequentiallynumbered);

alternationorrotation;dateofbirth;caserecordnumber;orotherexplicitlyunconcealedprocedures.

Thereisalowriskofperformancebiasifblindingofparticipantswasensuredanditwasunlikelythattheblinding

couldhavebeenbroken;oriftherewasnoblindingorincompleteblinding,butthereviewauthorsjudgethattheoutcomeisnotlikelytobeinfluencedbylackofblinding.

Thereisalowriskofperformancebiasifblindingofpersonnelwasensuredanditwasunlikelythattheblindingcouldhave

beenbroken;oriftherewasnoblindingorincompleteblinding,butthereviewauthorsjudgethattheoutcomeisnot

likelytobeinfluencedbylackofblinding.

Thereislowriskofbiasifallrandomizedpatientswerereported/analyzedinthegrouptowhichtheywereallocatedbyrandomization.I.e.,nodropoutsortheystateanalyzedas

ITT(unlessthere'sanobviousproblem).

trulyrepresentative;notrepresentative;OR

nodescriptiondrawnfromthesamesource;

notdrawnfromadifferentsource;ORnodescription

26517474 Maldonado 2015 na na na na na unclear low21620037 Calia 2011 NA NA NA NA NA trulyrepresentative drawnfromthesamesource

KDIGO-TransplantCandidateGuidelineTopic:PsychosocialQualityAssessment

PMID Author Year

26517474 Maldonado 201521620037 Calia 2011

NonRCT…..AscertainmentofexposureNonRCT…..Demonstrationthatoutcomeofinterestwasnot

presentatstartofstudyCOMPARATIVE....Baselinedifferencesbetweengroups

accountedforCOMPARATIVE...Outcomeassessmenttiming(across

interventions)ALL.....BlindingofOUTCOMEASSESSORS ALL.....Dropouts/missingdata(attritionbias)

AdditionalBias:Biasduetoproblemsnotcoveredelsewhereinthetable.Ifyes,describethemintheNotes.

securerecordorselfreport;notasecurerecordorself-report;OR

nodescriptionyes;no;unclear

ForRCT,LOWRoBunlessthereareimportantbaselinedifferencesthatarenotadjustedfor.FornRCS,HIGHRoBifunadjustedoradjustedonlyforageandsex;LOWRoBif

multivariateadjustment(morethanage/sex)orpropensityscoreanalysis.Thereislowriskofselectionbiasifgroupsaresimilaratbaselinefordemographicfactors,valueofmainoutcomemeasure(s),andimportantprognosticfactors

(examplesinthefieldofbackandneckpainaredurationandseverityofcomplaints,vocationalstatus,percentageof

patientswithneurologicalsymptoms).

Thereislowriskofdetectionbiasifoutcomeassessmentsforallinterventiongroupsweremeasuredatthesametime.If

theyreportresultsatmeanfollow-uptimes,thenHIGHriskofbias

Thereislowriskofdetectionbiasiftheblindingoftheoutcomeassessmentwasensuredanditwasunlikelythattheblindingcouldhavebeenbroken;oriftherewasnoblindingorincompleteblinding,butthereviewauthorsjudgethattheoutcomeisnotlikelytobeinfluencedbylackofblinding.;or:>>forpatient-reportedoutcomesinwhichthepatientwastheoutcomeassessor(e.g.,pain,disability):thereisalowriskofbiasforoutcomeassessorsifthereisalowriskofbiasfor

participantblinding.>>foroutcomecriteriathatareclinicalortherapeuticeventsthatwillbedeterminedbytheinteractionbetweenpatientsandcareproviders(e.g.,co-interventions,lengthofhospitalization,treatmentfailure),inwhichthecareprovideristheoutcomeassessor:thereisalowriskofbiasfor

outcomeassessorsifthereisalowriskofbiasforcareproviders.>>foroutcomecriteriathatareassessedfromdatafrommedicalforms:thereisalowriskofbiasifthetreatmentoradverseeffectsofthetreatmentcouldnotbenoticedinthe

extracteddata.

Thereisalowriskofattritionbiasiftherewerenomissingoutcomedata.Thepercentageofwithdrawalsanddrop-outsshouldnotexceed20%forshort-termfollow-upand30%forlong-termfollow-upandshouldnotleadtosubstantialbias.

Thereisalowriskofbiasifthestudyappearstobefreeofothersourcesofbiasnotaddressedelsewhere

low lowformortalityandgraftloss unclear unclear unclear unclear nonesecurerecord unclear NA NA unclear low none

Evidence Profile Guideline: Psychosocial testing

Outcome (Test)

# of Studies

Total N of Patients



Directness of the Evidence,

including Applicability



for Outcome

Description of Findings Importance of

Outcome

Death (SIPAT)

1 217 (55)*

Serious limitations

(-1)

N/A Indirect* (-1)

Sparse (-1)

Very low No association between pre-Txp SIPAT score and post-Txp mortality (across organ transplants)

Critical

Graft loss (SIPAT)

1 217 (55)*

Serious limitations

(-1)

N/A Indirect* (-1)

Sparse (-1)

Very low No association between pre-Txp SIPAT score and post-Txp graft loss (across organ transplants)

Critical

Graft loss (EPQ)

1 33 (33)

Serious limitations

(-1)

N/A Direct (0)

Sparse (-1)

Low Psychoticism, as assessed by the Eysneck Personality Questionnaire, was associated with a 30% rate of graft failure.

Critical

Non-adherence (SIPAT)

1 217 (55)*

Serious limitations

(-1)

N/A Indirect* (-1)

Sparse (-1)

Very low “Minimally acceptable to high risk” SIPAT score possibly associated with increased risk of post-Txp non-adherence (across organ transplants) (AUC P=0.058)

Moderate

Overall summary: Pre-transplant SIPAT score not associated with post-transplant mortality or graft loss (across organ transplants); possible association between high risk SIPAT score and non-adherence. Psychoticism on Eysneck Personality

Questionnaire associated with higher risk of graft failure.

Quality of Overall Evidence: Very low

Studies included in EP: PMID 26517474; PMID 21620037 Abbreviations: EPQ = Eysenck Personality Questionnaire; SIPAT = Stanford Integrated Psychosocial Assessment for Transplantation, Txp = transplant * 55 of 217 had kidney transplants. Others had heart (n=36), lung (n=68), and liver (n=58). No kidney transplant patients died or had graft loss at 1 year post-transplant.

KDIGO-NonadherenceGuidelineTopic:NonadherenceCategoricaloutcomes

PMID Author Year Typeofarticle CountryEra(Studyyears)

StudydesignAge[mean{SD}ormedian(range)]



Intervention-specificcharacteristic1


Arm(Intervention)

19459828 Dunn 2009 peer-reviewedjournalarticle USA 1982-2006 unclear nd nd CKD5 HD 1stgraftlossduetoNon-adherence,Retransplantedperprotocol

1stgraftlossnotduetonon-adherence1stgraftlossduetoNon-adherence,Retransplantedperprotocol1stgraftlossnotduetonon-adherence1stgraftlossduetoNon-adherence,Retransplantedperprotocol

1stgraftlossnotduetonon-adherence

KDIGO-NonadherenceGuidelineTopic:NonadherenceCategoricaloutcomes

PMID Author Year

19459828 Dunn 2009

Interventiondescription Outcome DefinitionOutcomemeasurementtimepoint

Samplesize(N)Frequency(event)rate,%


Selectiveretransplantprotocol Graftloss deathcensored 8years 35 45% HR1.51 0.11 C Alsodataat1,3,5years552 68%

Death 8years 35 68% HRnd 0.25(multivariate)552 72% Alsodataat1,3,5years

Graftlossduetonon-adherence 3514%(5)

0.00012ndgraftlossduetosimilarreasonsinthese5patients

552 2%(10)

KDIGO-TransplantCandidateGuidelineTopic:NonadherenceQualityAssessment


PMID Author Year





















19459828 Dunn 2009 N/A N/A N/A N/A N/A trulyrepresentative drawnfromthesamesource

KDIGO-TransplantCandidateGuidelineTopic:NonadherenceQualityAssessment

PMID Author Year

19459828 Dunn 2009

















extracteddata.



securerecord no low low low low Poorreporting.Omittedtheirpatientstransplantedelsewhere(againsttheir"protocol")

Evidence Profile Guideline: Nonadherence

Outcome # of Studies

Total N of Patients







for Outcome

Description of Findings Importance of Outcome

Death 1 587 Very serious limitations

(-2)

N/A Direct (0)

Sparse (-1)

Very low No difference between patients retransplanted after non-adherence vs. after adherence. No comparison with patients with non-adherence who were not retransplanted.

Critical

Graft loss 1 587 Very serious limitations

(-2)

N/A Direct (0)

Sparse (-1)

Very low No difference between patients retransplanted after non-adherence vs. after adherence. No comparison with patients with non-adherence who were not retransplanted.

Critical

Graft loss due to nonadherence

1 587 Very serious limitations

(-2)

N/A Direct (0)

Sparse (-1)

Very low Among originally non-adherent, 14% lost 2nd graft due to non-adherence; among originally adherent 2% lost 2nd graft due to non-adherence (P=0.0001). Among non-adherent, same reasons for non-adherence.

High

Overall summary: Overall patients who lost first graft due to non-adherence do as well after retransplantation as patients who lost first

graft for other reasons. No comparison with those who were not retransplanted


Studies included in EP: PMID 19459828


GuidelineTopic:DMtesting

Categoricaloutcomes

PMID Author Year Typeofarticle Country Era Studydesign Age

[mean{SD}or

median(range)]

%Male BaselineCKDstage Baselinekidney

function

BMIorweight Diabetesmeasurespretransplant Pre-TxpCategory Categorydescription

16499590 Shishido 2006 peer-reviewedpublication Japan 1999-2003 prospectiveobservationalstudy 9.7{5.4}(2.5,18)

64 ND CKD4-5 16.5kg/m2(12.2,26.8)

HbA1c:4.5 IGT,pre-Txp Impairedglucosetolerance–2hPG≥140mg/dLand<200

mg/dL

NGT,pre-Txp Normalglucosetolerance–2hPG<140mg/dL20169406 Iida 2010 peer-reviewedpublication Japan 2001-2006 retrospectiveobservationalstudy 37.5(19.7,51.2) 64 ND CKD4-5 20.9kg/m2 248(65.6%)patientsshowedthenormalIFGpattern(Group1)

115(30.4%)showedtheIFGorIGTpattern(IFG/IGT;Group2)15(4.0%)showedtheDMpattern(Group3)

IGT,pre-Txp IFG/IGTpatternwasdefinedasafastingbloodglucose

levelbetween100and125mg/dlora2-hglucoselevel

between140mg/dland199mg/dlintheOGTTOGTT

involvedtheadministrationof75gofglucose,was

performed2weeksbeforetransplantation.

NGT,pre-Txp Normalpatternwasdefinedasafastingbloodglucose

level<100mg/dlora2-hglucoselevel<140mg/dlinthe

OGTT.OGTTinvolvedtheadministrationof75gofglucose,

wasperformed2weeksbeforetransplantation.

IGT,pre-Txp IFG/IGTpatternwasdefinedasafastingbloodglucoselevelbetween100and125mg/dlora2-hglucoselevelbetween140mg/dland199mg/dlintheOGTTOGTTinvolvedtheadministrationof75gofglucose,wasperformed2weeksbeforetransplantation.

NGT,pre-Txp Normalpatternwasdefinedasafastingbloodglucoselevel<100mg/dlora2-hglucoselevel<140mg/dlintheOGTT.OGTTinvolvedtheadministrationof75gofglucose,wasperformed2weeksbeforetransplantation.

21949218 Chakkera 2011 peer-reviewedpublication US 1999-2008 retrospectiveobservationalstudy 49{15} 57 ND CKD4-5 27{6}kg/m2 FPG92{11}mg/dL IGT,pre-Txp patientswithFG≥100mg/dL

NGT,pre-Txp NoFG≥100mg/dL

21336240 Caillard 2011 peer-reviewedpublication France 2005-2008 retrospectiveobservationalstudy 50{14} 67 ND CKD4-5 25.4{4.4}kg/m2 IGTwasdiagnosedin37patients(15%) IGT,pre-Txp pretransplantIGTonpretransplantOGTT

NGT,pre-Txp normalGTonpretransplantOGTT

12480976 Mathew 2003 peer-reviewedpublication India 1996-1998 prospectiveobservationalstudy 32.9{9.7} 83.6 ND CKD4-5 18.3{2.4}kg/m2 2-hglucose>140mg/dL1-hglucose>156mg/dL

IGT,pre-Txp IGTorPTDMonpretransplantOGTT

NGT,pre-Txp NGTonpretransplantOGTT

PMID Author Year Typeofarticle Country Era Studydesign Age

[mean{SD}or

median(range)]

%Male BaselineCKDstage Baselinekidney

function

BMIorweight Diabetesmeasurespretransplant Pre-TxpCategory Categorydescription

24468096 Tokodai 2014 peer-reviewedpublication Japan 2000-2011 retrospectiveobservationalstudy 43.9 68 ND CKD4-5 21.3kg/m2 HbA1c:5.07% IGT,pre-Txp abnormalFPGonOGTT

NGT,pre-Txp normalFPGonOGTTNA RameshPrasad 2009 peer-reviewedpublication Canada 2003-2006 case-controlanalysis 49.8{10.5} 64 SCr132{34}µmol/L CKD4-5 75.6{18}kg OGTTabnormalitiespretransplant:(12of78)15% Impairedfastingglucose FBGbetween6.1and6.9mmol/l

Normalfastingglucose FBG<6.1mmol/l

Impairedglucosetolerance 2-hglucosebetween7.8and11.0mmol/l

Normalglucosetolerance 2-hglucose<7.8mmol/l

Abnormalrandombloodglucose RBG>6.0mmol/L

Normalrandombloodglucose RBG≤6.0mmol/L

OGTT


GuidelineTopic:DMtesting

Categoricaloutcomes

PMID Author Year

16499590 Shishido 2006

20169406 Iida 2010

21949218 Chakkera 2011

21336240 Caillard 2011

12480976 Mathew 2003

Outcome Definition Outcome

Measurement

Timepoint

Samplesize(N) Frequency

(Event)Rate,%

Relativeeffect Pvalue Sn(95%CI) Sp(95%CI) PPV(95%CI) NPV(95%CI) OverallQuality

PTDM Thedefinitionanddiagnosisofdiabetesaftertransplantationwasbasedon

thecurrentlyaccepteddefinitionofDMandIGTrecentlydefinedbytheWHO

1.5years 18 (0)0% ND ND A Children

37 (2)5.4% ND NDPermanentNODAT Patientswhodevelopedpermanentantiglycemicagent-dependentDM >2years 115 (7)6.1% OR2.59(0.85,7.88) 0.084 A

248 (6)2.4%

TransientNODAT Patientswhohadrequiredtransientantidiabetictherapymorethanonceduringthefollow-upperiod

>2years 115 (11)9.6% OR1.71(0.80,3.66) 1.16

248 (17)6.9%

NODAT NODATwasdiagnosedifapatienthadHbA1c≥6.5%,fastingvenousplasma

glucose≥126mg/dL,orwasreceivingdietormedicaltherapyfordiabetes

between1monthand1yearposttransplant

1year 72 (30)42% ND ND B

246 (55)22% ND ND

Multivariateanalysisusingastandardmodel,inwhichbothcontinuousand

discretevariableswereincludedandweightedaccordingtotheβ-coefficients

inthemultivariatelogistic

model

pretransplantFPGper10mg/dLincrease ND OR1.35(1.06,1.73) 0.02

Multivariateanalysisusingadichotomousmodel,inwhichcontinuous

variablesweredichotomizedbasedonclinicallyrelevantcutpoints(values

belowandabovethecutpoint

wereassignedavalueof0and1,respectively)andwereweightedaccording

totheβ-coefficientsinthemultivariatelogisticmodel

FG≥100mg/dL ND OR2.07(1.12,3.85) 0.02

NODAT Diagnosedifoneofthefollowingwaspresent:afastingglucoselevelmore

than126mg/dL(7mM/L)onatleasttwooccasions;anonfastingglucoselevel

morethan200mg/dL(11.1mM/L);a2-hrglucoselevelofastandardOGTT

morethan200mg/dL;ortheneedforantidiabeticmedication.IGTwas

definedbasedonADAguidelines(2-hrglucoselevelofastandardOGTT

between140and200mg/dL)

3years 22 (11)50% ND ND A

98 (20)20% ND NDMultivariateanalysis,theriskofdevelopingNODATincreaseinrecipientswith

oneriskfactorfromage(morethanorlessthan50years),typeof

nephropathy(ADPKDornot),andtheresultofpretransplantOGTT

(IGTornormal)

ND ND 2.4-fold(0.8,7) 0.1

Multivariateanalysis,theriskofdevelopingNODATincreaseinrecipientswith

tworiskfactorfromage(morethanorlessthan50years),typeof


(IGTornormal)

ND ND 5.2-fold(1.8,15) 0.02

Multivariateanalysis,theriskofdevelopingNODATincreaseinrecipientswith

threeriskfactorfromage(morethanorlessthan50years),typeof


(IGTornormal)

ND ND 14-fold(3,67) 0.01

PTDM PTDMbasedon1-hglucosevalue>50thpercentile 25.6months 80 ND OR2.9(1.2,6.9) 0.01 B

76 ND ref ref

PMID Author Year

24468096 Tokodai 2014

NA RameshPrasad 2009

Outcome Definition Outcome

Measurement

Timepoint

Samplesize(N) Frequency

(Event)Rate,%

Relativeeffect Pvalue Sn(95%CI) Sp(95%CI) PPV(95%CI) NPV(95%CI) OverallQuality

NODAT DefinedaccordingtotheAmericanDiabetesAssociation:asthepresenceof

diabetessymptomspluscasualplasmaglucoseconcentrations≥11.1mmol/L

(200mg/dL)orFPGconcentrations≥7mmol/L(126mg/dL);fastingwas

definedastheabsenceofcaloricintakeforatleast8h.Impairedfasting

glucosewasdefinedas5.6≤FPG<7mmol/L;multivariatelogisticregression

analysesadjustedbyrecipientage,gender,hepatitisCvirus,anduseof

tacrolimus

1year ND ND OR1.03(0.97,1.09) 0.38 A

ND ND ref refNODAT DefinedbasedonaminimumoftwoFBGmeasurements≥7.0mmol/Land/or

RBG≥11.1mmol/L,obtainedonseparatedaysintheabsenceofacuteillness

6months 8 (4)50% ND 0.03 B

DefinedbasedonaminimumoftwoFBGmeasurements≥7.0mmol/Land/orRBG≥11.1mmol/L,obtainedonseparatedaysintheabsenceofacuteillness

6months 143 (27)18% ND ref

DefinedbasedonaminimumoftwoFBGmeasurements≥7.0mmol/Land/or

RBG≥11.1mmol/L,obtainedonseparatedaysintheabsenceofacuteillness

6months 4 (3)75% ND 0.0006

DefinedbasedonaminimumoftwoFBGmeasurements≥7.0mmol/Land/orRBG≥11.1mmol/L,obtainedonseparatedaysintheabsenceofacuteillness

6months 147 (28)19% ND ref

multivariateanalysisofpretransplantRBG>6.0mmol/Ladjustedforacute

rejectionandageper10years

6months ND ND OR6.1(2.1,18.2) 0.001

multivariateanalysisofpretransplantRBG>6.0mmol/Ladjustedforacuterejectionandageper10years

6months ND ND ref ref

Performancecharacteristics valuesforOGTT 6months 151 23% 96% 58% 83%

KDIGO-TransplantCandidateGuidelineTopic:DMtestingQualityAssessment

RCT:Adequategenerationofarandomizedsequence RCT:.....Allocationconcealment RCT:.....BlindingofPATIENTS RCT:.....BlindingofPROVIDERS RCT.....Intention-to-treat-analysis NonRCT…..Selectionoftreatedandcontrolcohort?NonRCT…..Demonstrationthatoutcomeofinterestwasnot



interventions)

PMID Author Year


















drawnfromthesamesource;drawnfromadifferentsource;OR








16499590 Shishido 2006 NA NA NA NA NA NA NA NA NA17302602 Joss 2007 NA NA NA NA NA NA NA NA NA20169406 Iida 2010 NA NA NA NA NA NA NA NA NA21949218 Chakkera 2011 NA NA NA NA NA NA NA NA NA21336240 Caillard 2011 NA NA NA NA NA NA NA NA NA12480976 Mathew 2003 NA NA NA NA NA NA NA NA NA24468096 Tokodai 2014 NA NA NA NA NA NA NA NA NAND Nam 2001 NA NA NA NA NA NA NA NA NANA RameshPrasad 2009 NA NA NA NA NA NA NA NA NA

KDIGO-TransplantCandidateGuidelineTopic:DMtestingQualityAssessment

PMID Author Year

16499590 Shishido 200617302602 Joss 200720169406 Iida 201021949218 Chakkera 201121336240 Caillard 201112480976 Mathew 200324468096 Tokodai 2014ND Nam 2001NA RameshPrasad 2009

ALL.....BlindingofOUTCOMEASSESSORS ALL.....Dropouts/missingdata(attritionbias) Dxteststudies…..Referencestandard Dxteststudies….Samereferencestandard Dxtest….Independentreferencestandard Dxtest….InterpretationofresultsAdditionalBias:Biasduetoproblemsnotcoveredelsewhereinthetable.Ifyes,describe

themintheNotes.




extracteddata.


Didthewholesampleorarandomselectionofthesample,receiveverificationusingareferencestandardofdiagnosis?

[yes/no/unclear]

Didpatientsreceivethesamereferencestandardregardlessoftheindextestresult?[yes/no/unclear]

Wasthereferencestandardindependentoftheindextest(i.e.theindextestdidnotformpartofthereferencestandard)?

[yes/no/unclear]

Weretheindextestresultsinterpretedwithoutknowledgeoftheresultsofthereferencestandard?

[yes/no/unclear]


unclear low NA NA NA NA noneunclear low NA NA NA NA noneunclear low NA NA NA NA noneunclear low NA NA NA NA Nodescriptionofthetestasaninterventionpretransplantunclear low NA NA NA NA noneunclear low NA NA NA NA SomeinconsistenciesinthenumberofpatientsanalyzedbyOGTTandthosereceivingOGTTunclear low NA NA NA NA noneunclear low NA NA NA NA noneunclear low unclear unclear unclear yes none

Evidence Profile Guideline: Glucose tolerance testing pre-transplantation

Test (Outcome)

# of Studies

Total N of Patients







for Outcome


Outcome

IGT/IFG [vs. NGT] (NODAT)

7 >1163* No limitations (0)


(0)

Direct (0)

None (0)

High IGT pre-transplantation imparts an approximately double risk of NODAT 6 months to 3 years.

Moderate

RBG [vs. normal] (NODAT)

1 ≤151 Serious limitations

(-1)

N/A Direct (0)

Sparse (-1)

Low Abnormal RBG has significant association with NODAT (OR=6.1)

OGTT† (NODAT)

1 151 Serious limitations

(-1)

N/A Direct (0)

Sparse (-1)

Low Abnormal OGTT† has sensitivity = 23% for NODAT and specificity = 96%.

Overall summary: Patients with pre-transplant IGT or IFG are at increased risk of NODAT. However, pre-transplant OGTT has poor

sensitivity, but high specificity for NODAT.

Quality of Overall Evidence: High

Studies included in EP: PMID 16499590; PMID 20169406; PMID 21949218; PMID 21336240; PMID 12480976; PMID 24468096; PMID 19203506 Abbreviations: FG = fasting glucose, IGT/IFG = impaired glucose tolerance and/or impaired fasting glucose (e.g., FG 5.6-6.9 mmol/L (100-125 mg/dL), 2-hour glucose 7.8-10.9 mmol/L (140-196 mg/dL), N/A = not applicable, NGT = normal glucose tolerance, NODAT = new-onset diabetes after transplantation, OGTT = oral glucose tolerance test, RBG = random blood glucose >6.0 mmol/L (108 mg/dL). * 1 study did not report sample sizes. † FBG between 6.1 and 6.9 mmol/L (110-124 mg/dL) and/or 2-h glucose between 7.8 and 11.0 mmol/L (140-199)

KDIGO-TransplantCandidateGuidelineTopic:RecurrenceaHUSCategoricaloutcomes

PMID Author Year Typeofarticle Country Era Studydesign Age[mean{SD}ormedian(range)]

%Male BaselineCKDstage




Arm(Intervention) Interventiondescription

22958221 Zuber 2012 France Retrospectivecaseseries 0.8-33y ND 5D NA Eculizumabperi-transplantforaHUS(andhighriskforrecurrencebasedoncomplementmutationanalysis

1.Dose<24hbeforetransplantand2nddose<24haftertransplant;2.Dose1weekbeforetransplant;3.Plasmaexchangetherapyattimeoftransplantandconvertedtoeculizumabtherapy

(includingdatafrompreviouslypublishedcasereports)

24933457 Matar 2014 USA Retrospectivecaseseries 0.9-57y 33% 5D NA Eculizumabperi-transplantforaHUS(andhighriskforrecurrencebasedoncomplementmutationanalysis

Dose<24hbeforelivingdonortranssplant

NoeculizumabEculizumabperi-transplantforaHUS(andhighriskforrecurrencebasedoncomplementmutationanalysis

Dose<24hbeforelivingdonortranssplant

Noeculizumab

KDIGO-TransplantCandidateGuidelineTopic:RecurrenceaHUSCategoricaloutcomes

PMID Author Year

22958221 Zuber 2012

24933457 Matar 2014

InterventionDuration Outcome Definition OutcomeMeasurementTimepoint

Samplesize(N) Frequency(Event)Rate,%

Relativeeffect Pvalue OverallQuality

Lifetimeofallograft RecurrentaHUS ND variable 9withperi-transplanteculizumab 11% C

6min3patients,lifelongin1patient

Graftloss ND variable 4 0% B

8 50%6min3patients,lifelongin1patient

RecurrentaHUS ND variable 4 0%

8 38%

KDIGO-TransplantCandidateGuidelineTopic:RecurrenceFSGSCategoricaloutcomes




Intervention Interventionspecifics

11292291 Ohta 2001 Japan Retrospective,non-randomizedcontrolstudy

4.6+/-2.2y ND 5D NA PlasmapheresisbeforetransplantforFSGS

5,3and1daybeforetransplantation

21338460 Gonzalez 2011 USA Retrospective,non-randomizedwithhistoricalcontrols

12.8y 59% 5D NA PlasmapheresisbeforetransplantforFSGS

15605284 Hubsch 2005 USA 1999-2003(daclizumabinduction) Retrospective,non-randomized 7.0+/-4.0y 63% 5D NA PlasmapheresisbeforetransplantforFSGSNoplasmapheresis

1979-1998(pre-daclizumab) 7.0+/-4.0y 50% 5D NA PlasmapheresisbeforeNoplasmapheresis

1999-2003(daclizumabinduction)

1979-1998(pre-daclizumab)

16303004 Gohh 2005 USA Non-randomized,non-comparative 35+/-12y 40% 5D NA Preemptiveplasmapheresis

8sessionsofperi-operativeplasmapheresisinpatientsathighriskofFSGSrecurrence(priorrecurrenceinallograftorrapidprogressiontoESRD)

25715638 Lionaki 2015 Greece Non-randomized,non-comparative 30.9y 72% 5D NA immunoadsorption 3sessionsofimmunoadsorptionintheweekpriortotransplantand3sessionsintheweekaftertransplantforkidneytranpslantcandidateswithFSGSwithascheduledlivedonortransplant


PMID Author Year

11292291 Ohta 2001

21338460 Gonzalez 2011

15605284 Hubsch 2005

16303004 Gohh 2005

25715638 Lionaki 2015

Arm(Intervention) Interventiondescription InterventionDuration

Outcome Definition OutcomeMeasurementTimepoint



Pre-emptiveplasmapheresis RecurrentFSGS >1gmproteinuria,histologicevidenceofFSGSvialightmicroscopyorelectronmicroscopy

Variable 15 33% 0.5 NS(implied) C

Nopre-emptiveplasmapheresis 6 67%Graftsurvival Actuarial 1year 15 95% NS(unadjusted) C

6 65%3year 15 95%

6 65%5year 15 60%

6 67%Pre-emeptiveplasmapheresis >5sessions RecurrentFSGS >40mg/m2/hproteinuriaand

serumalbumin<3.0g/LVariable 10 40% NS(implied) C

<5sessions 7 71%Nopre-emptiveplasmaphersis Nosessions 17 59%

Pre-emptiveplasmapheresis 1-2sessions Graftloss >40mg/m2/hproteinuria Variable 10 0% Overall:0.1(0.0–1.7) 0.05 C

Nopre-emptiveplasmapheresis 2 50%

Pre-emptiveplasmapheresis 1-2sessions 2 50%Nopre-emptiveplasmapheresis 14 21%Pre-emptiveplasmapheresis 1-2sessions RecurrentFSGS >40mg/m2/hproteinuria Variable 10 90% ndNopre-emptiveplasmapheresis 2 50%Pre-emptiveplasmapheresis 1-2sessions 2 100%Nopre-emptiveplasmapheresis 14 36%Pre-emptiveplasmapheresis RecurrentFSGS >3gmproteinuria,biopsyshowing

footprocesseffacementonelectronmicroscopy

Variable 10 30% C

Pre-emptiveimmunoadsorption 3sessionspre-and3sessionspost-transplant

RecurrentFSGS >3gmproteinuria,biopsyfindingsc/wrecurrentFSGS

Variable 8 50% C

Nopre-emptiveimmunoadsorption 10 80%


PMID Author Year Typeofarticle Country Era StudydesignAge

[mean{SD}ormedian(range)]

%MaleBaselineCKD

stageBaselinekidney

functionIntervention-specific

characteristic1Intervention-specificcharacteristic2 Arm(Intervention)

11292291 Ohta 2001 Japan Retrospective,non-randomizedcontrolstudy 4.6+/-2.2 ND 5-D NA Plasmapheresis(prophylactic) 5,3and1daybeforetransplantation PlasmapheresisNoplasmapheresis


PMID Author Year

11292291 Ohta 2001

Interventiondescription

InterventionDuration

Outcome DefinitionOutcome

MeasurementTimepoint

Samplesize(N) BaselineValue FinalValue Change Pvalue OverallQuality

Proteinuria g/d Variable 15 ND 16.9 NA NA C6 ND 51.2 NA NA

Evidence Profile Guideline: Treatments to prevent kidney disease recurrence

Disease (Treatment)


Total N of Patients



Directness of the

Evidence, including

Applicability



for Outcome


Outcome

FSGS (plasmapheresis)


(-2)


(0)

Direct (0)

Small, sparse, old (-2)

Very low

No difference plasmapheresis vs. none

Critical

Recurrent FSGS


(-2)


(0)

Direct (0)

Small, mostly old (-2)

Very low

No difference plasmapheresis vs. none

High

aHUS (eculizumab)

Graft loss 1 12 Serious limitations

(-1)

N/A Direct (0)

Small, sparse (-2)

Very low

Possible lower rate with eculizumab Critical

Recurrent aHUS

2 21* Very serious limitations

(-2)


(0)

Direct (0)

Small, sparse (-1)

Very low

Possible lower rate with eculizumab High

Overall summary: Unclear evidence that plasmapheresis does not affect FSGS recurrence or graft loss, but that eculizumab

may lower rates of aHUS recurrence and graft loss.


Studies included in EP: 11292291, 21338460, 15605284, 16303004, 25715638, 22958221, 24933457. Abbreviations: aHUS = atypical hemolytic uremic syndrome, FSGS = focal segmental glomerulosclerosis, N/A = not applicable. * Includes case reports

KDIGO-TransplantCandidateGuidelineTopic:NephrectomyCategoricaloutcomes



%MaleBaselineCKD

stageBaselinekidney

functionReasonfornephrectomy Arm(Intervention)

9610554 Erturk 1998 peer-reviewedpublication US 1984-1995 prospectivecohortstudy 31(10-67) 55.5 ND ND vesicoureteralreflux nephrectomypriortotxp

correctedreflux

persistentreflux

nephrectomypriortotxpcorrectedrefluxpersistentrefluxnephrectomypriortotxpcorrectedrefluxpersistentrefluxnephrectomypriortotxpcorrectedrefluxpersistentrefluxreflux

norefluxreflux

reflux

14724448 Ramos 2004 peer-reviewedpublication US ND retrospectivecohortstudy 45.3 100 ND CKD5 BKvirus-associatednephropathy

nephrectomyoffirstgraft

KDIGO-TransplantCandidateGuidelineTopic:NephrectomyCategoricaloutcomes

PMID Author Year

9610554 Erturk 1998

14724448 Ramos 2004

Interventiondescription Outcome DefinitionOutcome


Samplesize(N)Frequency

(Event)Rate,%Relativeeffect Pvalue OverallQuality

bilateralnephrectomypriortotransplantation complicatedUTI afterTxp meanf/u:4.5years 8 (3)38% ND NS C

vesicoureteralrefluxcorrectedpriortotransplantation 10 (1)10% NS

persistentvesicoureteralrefluxaftertransplantation 18

(6)33% ref

uncomplicatedUTI afterTxp meanf/u:4.5years 8 (4)50% ND NS10 (3)30% NS18 (11)61% ref

graftsurvival 2years 8 (6)75% ND ND10 (7)70%18 (11)61%

6years 8 (5)63% ND NS10 (1)10% NS18 (6)33% ref

includingnephrectomypriortotxp,correctedreflux,persistentreflux

3year 36 (15)47% ND Sig

non-refluxKTxppopulation 155 (117)75% refincludingnephrectomypriortotxp,correctedreflux,persistentreflux

patientsurvival 1year 36 (35)96% NA NAincludingnephrectomypriortotxp,correctedreflux,persistentreflux

5years 36 (33)92% NA NAgraftnephroureterectomyafterlosinggraftfunctionastheresultofBKANwithsubsequentretransplantation

BKANrecurrence afterTxp 8mo 10 (1)10% NA NA

C

KDIGO-TransplantCandidateGuidelineTopic:NephrectomyQualityAssessment

RCT:Adequategenerationofarandomizedsequence RCT:.....Allocationconcealment RCT:.....BlindingofPATIENTS RCT:.....BlindingofPROVIDERS RCT.....Intention-to-treat-analysis NonRCT…..Selectionoftreatedandcontrolcohort?

PMID Author Year



















nodescription

9610554 Erturk 1998 NA NA NA NA NA low14724448 Ramos 2004 NA NA NA NA NA NA

KDIGO-TransplantCandidateGuidelineTopic:NephrectomyQualityAssessment

PMID Author Year

9610554 Erturk 199814724448 Ramos 2004

NonRCT…..Demonstrationthatoutcomeofinterestwasnotpresentatstartofstudy

COMPARATIVE....Baselinedifferencesbetweengroupsaccountedfor

COMPARATIVE...Outcomeassessmenttiming(acrossinterventions)

ALL.....BlindingofOUTCOMEASSESSORS ALL.....Dropouts/missingdata(attritionbias)AdditionalBias:Biasduetoproblemsnotcoveredelsewherein

thetable.Ifyes,describethemintheNotes.

yes;no;unclear










extracteddata.



low unclear low unclear low noneNA NA NA unclear low none

Evidence Profile Guideline: Transplantation outcomes after pre-transplant nephrectomy for UTI or BKAN

Outcome (Kidney Disease)

# of Studies

Total N of Patients



Directness of the

Evidence, including

Applicability



for Outcome


Outcome

Death (UTI) 1 (UTI)

36 Very serious limitations

(-2) *†

N/A Indirect (-1) *

Sparse, small (-2)

Very low

Overall survival rate in patients with reflux was high at long-term follow-up (>90% at 5 years)

Critical

Graft Loss (UTI)

1 (UTI)


(-2) *†

N/A Direct (0)

Sparse, small (-2)

Very low

No significant difference was shown between nephrectomy and no nephrectomy at long-term

follow-up

Critical

Complicated UTI (UTI)

1 (UTI)


(-2) *†

N/A Direct (0)

Sparse, small (-2)

Very low


follow-up

High

Uncomplicated UTI (UTI)

1 (UTI)


(-2) *†

N/A Direct (0)

Sparse, small (-2)

Very low


follow-up

Moderate

BKAN Recurrence (BKAN)

1 (BKAN)


(-2) *†

N/A Indirect (-1) *

Sparse, small (-2)

Very Low

Recurrence rate was 10% in short-term follow-up after transplantation with pre-transplant

nephrectomy

High

Overall summary: Post-transplant survival high after nephrectomy for vesicoureteral reflux; graft loss rates similar.

A percentage of patients with BKAN have recurrence post-transplant after nephrectomy.


Studies included in EP: PMID 9610554; PMID 14724448 Abbreviations: BKAN = BK virus associated nephropathy; UTI = Urinary tract infection / vesicoureteral reflux , N/A = Not applicable, BKAN = BK virus-associated nephropathy * The study did not compare the effect of nephrectomy with no nephrectomy on patient outcome. † Potential confounding effects were not adjusted in the non-randomized controlled study. BKAN study was noncomparative.

KDIGO-TransplantCandidateGuidelineTopic:TBTreatmentCategoricaloutcomes


%Male BaselineCKDstage Baselinekidneyfunction

Arm(Intervention) Interventiondescription

27548035 Simkins 2016 peer-reviewedpublication US 2012-2014 retrospectivecohortstudy 59.81{10.22} 66% CKD4:2%CKD5-ND:5%CKD5-D:94%

ND ShortcourseTBtreatment RPT900mg+INH15mg/kg

FullcourseTBtreatment INH5mg/kg

10970979

Vachharajani 2000 peer-reviewedpublication India 198-1991 Retrospective"NRCS" 39.9{12.7} 67% HD100% nd ShortcourseTBtreatment H200mg,R450mg,Z750mg,E800mg,doseadjustedforptwithliverdysfunction

FullcourseTBtreatment H200mg,R450mg,Z750mg,E800mg,doseadjustedforptwithliverdysfunction

Malhotra 1986 peer-reviewedarticle India nd nd [28.9] 82% CKD5 HD ShortcourseTBtreatment Isoniazid200mg/day+EMB7.5mg/kg/day+Rifampin450-600mg/day+Pyridoxine10mg/day

24142036 LopezdeCastilla 2014 peer-reviewedpublication US 2012 prospectivecohortstudy total:57(33-75) total:82% ND ND ShortcourseTBtreatment Rifapentine750-900mg+Isoniazid15mg/kgQW

KDIGO-TransplantCandidateGuidelineTopic:TBTreatmentCategoricaloutcomes

PMID Author Year

27548035 Simkins 2016

10970979

Vachharajani 2000

Malhotra 1986

24142036 LopezdeCastilla 2014

InterventionDuration Outcome Definition OutcomeMeasurementTimepoint



12week TBreactivation ND mean2.5years 43 (0)0% Same:Noeventseitherarm

ND B

9months 110 (0)0%6moin2pt,3moin2pt TBreactivation post-transplant ND 4 (0)0% nd nd C

HR1y,ZE2-3mo, TBreactivation post-transplant ND 4 (0)0% nd nd

3to6months patientsurvival 1.5-6.5years 11 64% nd nd C

3to6months TBreactivation post-transplant 1.5-6.5years 11 9% nd nd4to6months graftloss chronicrejection 1.5-6.5years 11 18% nd nd12weeks TBreactivation ND ND 8 (0)0% NA B


GuidelineTopic:TBTreatment

QualityAssessment

RCT:Adequategenerationofarandomizedsequence RCT:.....Allocationconcealment RCT:.....BlindingofPATIENTS RCT:.....BlindingofPROVIDERS RCT.....Intention-to-treat-analysis NonRCT…..Selectionoftreatmentandcontrolcohort?NonRCT…..Demonstrationthatoutcomeofinterestwasnot

presentatstartofstudy

PMID Author Year

Thereisalowriskofselectionbiasiftheinvestigatorsdescribe

arandomcomponentinthesequencegenerationprocesssuch

as:referringtoarandomnumbertable,usingacomputer

randomnumbergenerator,cointossing,shufflingcardsor

envelopes,throwingdice,drawingoflots,minimization

(minimizationmaybeimplementedwithoutarandom

element,andthisisconsideredtobeequivalenttobeing

random).Thereisahighriskofselectionbiasifthe

investigatorsdescribeanon-randomcomponentinthe

sequencegenerationprocess,suchas:sequencegeneratedby

oddorevendateofbirth,date(orday)ofadmission,hospital

orclinicrecordnumber;orallocationbyjudgementofthe

clinician,preferenceoftheparticipant,resultsofalaboratory

testoraseriesoftests,oravailabilityoftheintervention.

Thereisalowriskofselectionbiasiftheparticipantsand

investigatorsenrollingparticipantscouldnotforesee

assignmentbecauseoneofthefollowing,oranequivalent

method,wasusedtoconcealallocation:centralallocation

(includingtelephone,web-basedandpharmacy-controlled

randomization);sequentiallynumbereddrugcontainersof

identicalappearance;orsequentiallynumbered,opaque,

sealedenvelopes.Thereisahighriskofbiasifparticipantsor

investigatorsenrollingparticipantscouldpossiblyforesee

assignmentsandthusintroduceselectionbias,suchas

allocationbasedon:usinganopenrandomallocationschedule

(e.g.alistofrandomnumbers);assignmentenvelopeswere

usedwithoutappropriatesafeguards(e.g.ifenvelopeswere

unsealedornon-opaqueornotsequentiallynumbered);

alternationorrotation;dateofbirth;caserecordnumber;or

otherexplicitlyunconcealedprocedures.

Thereisalowriskofperformancebiasifblindingof

participantswasensuredanditwasunlikelythattheblinding

couldhavebeenbroken;oriftherewasnoblindingor

incompleteblinding,butthereviewauthorsjudgethatthe

outcomeisnotlikelytobeinfluencedbylackofblinding.

Thereisalowriskofperformancebiasifblindingofpersonnel

wasensuredanditwasunlikelythattheblindingcouldhave

beenbroken;oriftherewasnoblindingorincomplete

blinding,butthereviewauthorsjudgethattheoutcomeisnot


Thereislowriskofbiasifallrandomizedpatientswere

reported/analyzedinthegrouptowhichtheywereallocated

byrandomization.I.e.,nodropoutsortheystateanalyzedas


drawnfromthesamesource;drawnfromadifferentsource;

OR

nodescription

yes;no;unclear

27548035 Simkins 2016 NA NA NA NA NA low NA24142036 LopezdeCastilla 2014 NA NA NA NA NA low NA

Malhorta 1986 nd nd nd nd nd nodescription nodescription

10970979 Vachharajani 2000 NA NA NA NA NA High High


GuidelineTopic:TBTreatment

QualityAssessment

PMID Author Year

27548035 Simkins 201624142036 LopezdeCastilla 2014

Malhorta 1986

10970979 Vachharajani 2000

COMPARATIVE....Baselinedifferencesbetweengroups

accountedfor

COMPARATIVE...Outcomeassessmenttiming(across


AdditionalBias:Biasduetoproblemsnotcoveredelsewherein


ForRCT,LOWRoBunlessthereareimportantbaseline

differencesthatarenotadjustedfor.FornRCS,HIGHRoBif

unadjustedoradjustedonlyforageandsex;LOWRoBif

multivariateadjustment(morethanage/sex)orpropensity

scoreanalysis.Thereislowriskofselectionbiasifgroupsare

similaratbaselinefordemographicfactors,valueofmain

outcomemeasure(s),andimportantprognosticfactors

(examplesinthefieldofbackandneckpainaredurationand

severityofcomplaints,vocationalstatus,percentageof


Thereislowriskofdetectionbiasifoutcomeassessmentsfor

allinterventiongroupsweremeasuredatthesametime.If

theyreportresultsatmeanfollow-uptimes,thenHIGHriskof

bias

Thereislowriskofdetectionbiasiftheblindingofthe

outcomeassessmentwasensuredanditwasunlikelythatthe

blindingcouldhavebeenbroken;oriftherewasnoblindingor


outcomeisnotlikelytobeinfluencedbylackofblinding.;or:

>>forpatient-reportedoutcomesinwhichthepatientwasthe

outcomeassessor(e.g.,pain,disability):thereisalowriskof

biasforoutcomeassessorsifthereisalowriskofbiasfor

participantblinding.>>foroutcomecriteriathatareclinicalor

therapeuticeventsthatwillbedeterminedbytheinteraction

betweenpatientsandcareproviders(e.g.,co-interventions,

lengthofhospitalization,treatmentfailure),inwhichthecare

provideristheoutcomeassessor:thereisalowriskofbiasfor

outcomeassessorsifthereisalowriskofbiasforcare

providers.>>foroutcomecriteriathatareassessedfromdata

frommedicalforms:thereisalowriskofbiasifthetreatment

oradverseeffectsofthetreatmentcouldnotbenoticedinthe

extracteddata.

Thereisalowriskofattritionbiasiftherewerenomissing

outcomedata.Thepercentageofwithdrawalsanddrop-outs

shouldnotexceed20%forshort-termfollow-upand30%for

long-termfollow-upandshouldnotleadtosubstantialbias.

Thereisalowriskofbiasifthestudyappearstobefreeof

othersourcesofbiasnotaddressedelsewhere

low low unclear high low

NA NA unclear low high,caseseriessecurerecordorselfreport no nd nd low low Pyridoxinewasgiven(10mg/day)inpatientsreceiving

isoniazidduringpre-transplantchemotherapy.Numberof

chemopatientsnotdefined.

Low No Unclear Unclear Unclear Low Allpatientscompletedfullcourseoftreatment,whilehalfof

themhadKTxpinthemiddleoftreatmentcourseintheshorter

coursegroup

Evidence Profile Guideline: Tuberculosis treatment, short vs. full course


Total N of Patients







for Outcome


Outcome

Death 1 11 Very serious limitations

(-2)

N/A Direct (0)

Sparse, small (-2)

Very low 1/3 dead up to 6.5 years after short course (3-6 mo) TB treatment and KTx

Critical


(-2)

N/A Direct (0)

Sparse, small (-2)

Very low 2/11 with graft loss up to 6.5 years after short course (3-6 mo) TB treatment

Critical

TB activation 4 180 (4-110)

Very serious limitations

(-2)


(0)

Direct (0)

None (0)

Low No reactivations in 2 comparative studies 3-6 mo vs. 1 year TB treatment; 1 reactivation among 66 patients with short course TB treatment (3-6 mo)

High

Overall summary: TB is rare post-transplantation in patients treated with short course (3-6 months) of TB

treatment


Studies included in EP: PMID 27548035; PMID 10970979; PMID 3532083; PMID 24142036 Abbreviations: KTx = kidney transplantation, TB = tuberculosis

KDIGO-TransplantCandidateGuidelineTopic:TBTestingCategoricaloutcomes

PMID Author Year Typeofarticle Country Era(Studyyears)

Studydesign Age[mean{SD}ormedian(range)]



Arm(Cohort) Cohortdescription Outcome

22236928 Jung 2012 peer-reviewedjournalarticle SouthKorea 2000-2010 retrospective [42(17-23)] 62% CKD5 HD TuberculinSkinTest TSTwasconductedbeforetransplantaccordingtothepre-transplantevaluationprotocol.

TSTPositive

TuberculinSkinTest post-transplantTBTuberculinSkinTest+TuberculinSkinTest-TuberculinSkinTest+/TBexposureorh/oTBTuberculinSkinTest-/TBexposureorh/oTB

TuberculinSkinTestNA/TBexposureorh/oTBTuberculinSkinTest+/noTBexposure,noh/oTB

TuberculinSkinTest-/noTBexposure,noh/oTBTuberculinSkinTestNA/noTBexposure,noh/oTBTBexposureorh/oTBnoTBexposure,noh/oTBh/oTB PreviouslyhealedTBonCXRnoh/oTBh/oTB PreviousTBhistorynoh/oTB

22802098 Kim 2013 peer-reviewedjournalarticle SouthKorea 2010-2012 prospective [47(20-69)] 56% CKD5 HD TuberculinSkinTest One-stepTSTwasconductedbeforeelectivetransplantsurgery.

TSTPositive

One-stepTSTwasconductedbeforeelectivetransplantsurgery.

TSTPositive

QuantiFERON-TBGoldIn-Tubetest(QFT-GIT) TB-specificAg+QuantiFERON-TBGoldIn-Tubetest(QFT-GIT) TB-specificAg-QuantiFERON-TBGoldIn-Tubetest(QFT-GIT) TB-specificAgindeterminatePost-txpcheck Checkforrespiratorysymptoms,physical

examination,chestradiography,andsputumanalysisvery1-2monthsformeanfollow-upof387days(13-661).

TB+

KDIGO-TransplantCandidateGuidelineTopic:TBTestingCategoricaloutcomes

PMID Author Year

22236928 Jung 2012

22802098 Kim 2013

Definition Samplesize(N) Frequency(event)rate,%

Relativeeffect Adjustedfor Pvalue Overallquality

Indurationof⩾5mmdiameter 729 0.313 nd nd B

729 2% nd nd228 3.5% aOR3.50(1.12,10.93) age,sex,BMI,DM,previouslyhealedTBonCXR,TBhistory,CMVserologicalmismatching,HLAmismatching 0.031501 1.0% ref ref18 0.0% nd nd20 10.0% RR4.21(1.67,10.61)

(vsTST-negative/noTBexposureandnoh/oTB)0.002

17 11.8% nd nd210 3.8% RR6.31(1.66,24.03)

(vsTST-negative/noTBexposureandnoh/oTB)0.007

481 0.6% ref ref351 2.3% nd nd55 7.3% RR4.22(1.39,12.87) 0.0111042 1.8% ref refnd nd aOR8.69(1.00,75.51) age,sex,BMI,DM,TST+,TBhistory,CMVserologicalmismatching,HLAmismatching 0.05nd nd ref refnd nd aOR0.24(0.01,4.11) age,sex,BMI,DM,previouslyhealedTBonCXR,TST+,CMVserologicalmismatching,HLAmismatching 0.322nd nd ref ref

TST>=5mm 119 29% nd nd B

TST>=10mm 119 19% nd nd

126 42% nd nd126 53% nd nd126 5% nd nd

positiveresult 126 0% nd nd


GuidelineTopic:TBTesting

QualityAssessment


PMID Author Year













































trulyrepresentative;

notrepresentative;OR

nodescription

drawnfromthesamesource;

notdrawnfromadifferentsource;OR

nodescription

22236928 Jung 2012 N/A N/A N/A N/A N/A nodescription drawnfromthesamesource

22802098 Kim 2013 N/A N/A N/A N/A N/A trulyrepresentative drawnfromthesamesource


GuidelineTopic:TBTesting

QualityAssessment

PMID Author Year

22236928 Jung 2012

22802098 Kim 2013




accountedfor





securerecordorselfreport;

notasecurerecordorself-report;OR

nodescription

yes;no;unclear














bias


















extracteddata.







securerecord no N/A N/A low low

securerecord no N/A N/A low low TSTdatamissingforn=9patients.

Evidence Profile Guideline: Tuberculosis testing


Total N of Patients







for Outcome


Outcome

TB post-Txp 2 848 Serious limitations

(-1)


(-2)

Direct (0)

None Very low One study from South Korea found TST to be strong predictor of post-Txp TB. However, another study from South Korea found equal rates of post-Txp TB regardless of pre-Txp TST (0% in South Korea).

High

Overall summary: TST pre-transplant does not consistently predict post-transplant tuberculosis


Studies included in EP: PMID 22236928; PMID 22802098 Abbreviations: TB = tuberculosis, TST = tuberculin skin test, Txp = transplant. * A third study from South Korea found no incidence of post-transplant tuberculosis

KDIGO-TransplantCandidateGuidelineTopic:HBVVaccineCategoricaloutcomes

PMID Author Year Typeofarticle CountryEra

(Studyyears)Studydesign

Age[mean{SD}ormedian(range)]

%MaleBaselineCKD

stageBaselinekidney

functionArm(Intervention) Interventiondescription

21114569 Potsangbam 2011 peer-reviewedjournalarticle India 2007-2008 unclear [35.38{9.48}] 94 CKD5 HD recombinantHBVvaccine,2doses 2dosesat40microgramseach

recombinantHBVvaccine,3doses 3dosesat40microgramseach

recombinantHBVvaccine,4doses 4dosesat40microgramseach

28457920 Kauke 2017 peer-reviewedpublication Germany 2005-2012 retrospectivecohortstudy 49.68 34.6 CKD5 nd HBVvaccination administeredduringdialysispriortotransplantation

KDIGO-TransplantCandidateGuidelineTopic:HBVVaccineCategoricaloutcomes

PMID Author Year

21114569 Potsangbam 2011

28457920 Kauke 2017

Interventionduration


measurementtimepoint


(event)rate,%Relativeeffect Pvalue Overallquality

12months Anti-HBsAgtitres(IU/L) >100 12months 17 84% nd NSoverall CAnti-HBsAgtitres(IU/L) >100 12months 17 5% ndAnti-HBsAgtitres(IU/L) >100 12months 17 11% nd

12months Anti-HBsAgtitres(IU/L) <10 12months 17 61.1% ndAnti-HBsAgtitres(IU/L) 10-100 12months 17 5.6% ndAnti-HBsAgtitres(IU/L) >100 12months 17 33.3% nd

12months Anti-HBsAgtitres(IU/L) <10 12months 12 61.5% ndAnti-HBsAgtitres(IU/L) 10-100 12months 12 5.6% ndAnti-HBsAgtitres(IU/L) >100 12months 12 23.1% nd

median5.5years Anti-HBsAgtitres(IU/L) >10 nd 188 141(75%) nd nd B

5-yeargraftsurvival nd 5years 188 93.6% nd nd

KDIGO-TransplantCandidateGuidelineTopic:HBVVaccineQualityAssessment


PMID Author Year





















0 Potsangbam 2011 N/A N/A N/A N/A N/A nodescription drawnfromthesamesource

28457920 Kauke 2017 nn N/A N/A N/A N/A trulyrepresentative drawnfromthesamesource

KDIGO-TransplantCandidateGuidelineTopic:HBVVaccineQualityAssessment

PMID Author Year

0 Potsangbam 2011

28457920 Kauke 2017

















extracteddata.



securerecord no N/A N/A low low Pre-transplantvaccinepatietnsnotseparatedout.HBVvaccinetypenotmentioned.

securerecord no N/A N/A unclear low none

KDIGO-TransplantCandidateGuidelineTopic:VaccineMeaslesCategoricaloutcomes




%MaleBaselineCKD

stageBaselinekidney

functionArm(Intervention)

Interventiondescription

19438829 Mori 2009 peer-reviewedjournalarticle Japan 1990-2002 retrospective [7.9{4.8}] 60% CKD5 HD livemeaslesvaccine

KDIGO-TransplantCandidateGuidelineTopic:VaccineMeaslesCategoricaloutcomes

PMID Author Year

19438829 Mori 2009

Outcome DefinitionOutcomemeasurement

timepointSamplesize(N)

Frequency(event)rate,%


Seroconversion seroconversion 1yearaftertransplant 19 89.5%(17) nd C2yearsaftertransplant 9 100%(9)

KDIGO-TransplantCandidateGuidelineTopic:VaccineMeaslesQualityAssessment


PMID Author Year





















19438829 Mori 2009 N/A N/A N/A N/A N/A trulyrepresetnative drawnfromthesamesource

KDIGO-TransplantCandidateGuidelineTopic:VaccineMeaslesQualityAssessment

PMID Author Year

19438829 Mori 2009

















extracteddata.



securerecord no N/A N/A low high(only19/42evaluatedat1yearand9/42at2years)

Evidence Profile Guideline: Pre-transplant vaccination

Vaccine (Outcome)

# of Studies

Total N of Patients



Directness of the

Evidence, including

Applicability



for Outcome


Outcome

HBV (Post-Txp titers)


(-2)

N/A Direct (0)

Sparse (-1)

Very Low

Higher titers with 3 or 4 pre-Txp doses than with 2, but underpowered so nonsignificant. Vaccination during dialysis prior to transplantation led to positive responses and greater survival post-transplant.

High

Measles (Post-Txp seroconversion)


(-2)

N/A Direct (0)

Sparse, small (-2)

Very low

90% retained seroconversion 1 year after Txp High

Overall summary: Pre-transplantation vaccination for HBV and measles is successful to maintain post-

transplantation immunity. Three or four HBV doses may be more effective than only two.


Studies included in EP: PMID 21114569, PMID 28457920, PMID 19438829. HBV = hepatitis B vaccination, N/A = not applicable, Txp = transplant

KDIGO-TransplantCandidateGuidelineTopic:HIVCategoricaloutcomes


[mean{SD}ormedian(range)]%Male

BaselineCKDstage


CD4+Tcell[mean{SD}ormedian(range)]

HIVRNAundetectable

(%)

Arm(Intervention/Predictor)

Armdescription

26765937 Roland 2016 peer-reviewedpublication US 2003-2010 prospectivecohortstudy 45[39-52] 84 CKD4-5 ND 465[313-600]NadirCD4+T-cells:257[117-428]

100 HIV+KTxp kidneytransplantinHIVinfectedpatients

HIV+NoKTx Transplantcandidatesdidnotreceiveatransplantduetolackoforganavailability,nolongermeetingstudyeligibilityrequirements,beingtransplantedoff-study,dyingbeforeanorganbecameavailable,inabilitytoadheretothestudyrequirements,theirowndecision,orthestudyreachingitsenrollmentcap.

HIV+KTxp kidneytransplantinHIVinfectedpatients

HIV+NoKTx Transplantcandidatesdidnotreceiveatransplantduetolackoforganavailability,nolongermeetingstudyeligibilityrequirements,beingtransplantedoff-study,dyingbeforeanorganbecameavailable,inabilitytoadheretothestudyrequirements,theirowndecision,orthestudyreachingitsenrollmentcap.

25807035 Sawinski 2015 peer-reviewedpublication US 1996-2003 retrospectivecohortstudy HIV-52(IQR:41-61),HIV+46(IQR:41-56) 60 CKD4-5 ND ND ND

HIV+KTxp FirstkidneytransplantinHIVinfectedpatients

HIV-KTxp FirstkidneytransplantinHIVuninfectedpatients

HIV+KTxp FirstkidneytransplantinHIVinfectedpatients

HIV-KTxp FirstkidneytransplantinHIVuninfectedpatients

15153575 Abbott 2004 peer-reviewedpublication US 1996-2001 retrospectivecohortstudy 48.2{10.6} ND CKD4-5 ND ND ND HIV+KTxp kidneytransplantinHIVinfectedpatients

HIV-KTxp kidneytransplantinHIVuninfectedpatients

HIV+vs.HIV-KTxp kidneytransplantinHIVinfectedpatients



24621536 Malat 2014 peer-reviewedpublication US 1987-2012 case-controlanalysis 47.4{9.4} 7800% CKD4-5 ND ND ND HIV+KTxp kidneytransplantinHIVinfectedpatients


HIV+KTxp kidneytransplantinHIVinfectedpatientsHIV-KTxp kidneytransplantinHIVinfectedpatients

Xia 2014 peer-reviewedpublication US 2000-2013 retrospectiveobservationalstudy 48.1{8.8} 77 CKD4-5 ND ND ND HIV+KTxp kidneytransplantinHIVinfectedpatients;14.8%werealsoHCV+

HIV-KTxp kidneytransplantinHIVorHCVuninfectedpatients

HIV+KTxp kidneytransplantinHIVinfectedpatients;14.8%werealsoHCV+


HIV+vs.HIV-KTxp kidneytransplantinHIVinfectedpatients;14.8%werealsoHCV+





HIV+vs.HIV-KTxp kidneytransplantinHIVinfectedpatients;14.8%werealsoHCV+


[mean{SD}ormedian(range)]%Male

BaselineCKDstage


CD4+Tcell[mean{SD}ormedian(range)]

HIVRNAundetectable

(%)

Arm(Intervention/Predictor)

Armdescription

25791727 Locke 2015 peer-reviewedpublication US 2002-2011 registry nd 79.2 nd nd nd nd HIV+KTxp kidneytransplantinHIVinfectedpatients

HIV-KTxp matchedcontrols(kidneytransplantinHIVuninfectedpatients)


HIV+KTxp matchedcontrols(kidneytransplantinHIVuninfectedpatients)

HIV+ /HCV- KTxp kidneytransplantinHIVinfectedandHCVuninfectedpatients

HIV- /HCV- Ktxp matchedcontrols(kidneytransplantinHIVuninfectedandHCVuninfectedpatients)

HIV+ /HCV- KTxp kidneytransplantinHIVinfectedandHCVuninfectedpatients

HIV- /HCV- Ktxp matchedcontrols(kidneytransplantinHIVuninfectedandHCVuninfectedpatients)

HIV+ /HCV+KTxp kidneytransplantinHIVinfectedandHCVinfectedpatients

HIV-/HCV+ KTxp matchedcontrols(kidneytransplantinHIVuninfectedandHCVinfectedpatients)

HIV+ /HCV+ KTxp kidneytransplantinHIVinfectedandHCVinfectedpatients

HIV-/HCV+KTxp matchedcontrols(kidneytransplantinHIVuninfectedandHCVinfectedpatients)


HIV- KTxp matchedcontrols(kidneytransplantinHIVuninfectedpatients)


HIV- KTxp matchedcontrols(kidneytransplantinHIVuninfectedpatients)

HIV+ /HCV-KTxp kidneytransplantinHIVinfectedandHCVuninfectedpatients

HIV- /HCV-Ktxp matchedcontrols(kidneytransplantinHIVuninfectedandHCVuninfectedpatients)

HIV+ /HCV-KTxp kidneytransplantinHIVinfectedandHCVuninfectedpatients

HIV- /HCV-Ktxp matchedcontrols(kidneytransplantinHIVuninfectedandHCVuninfectedpatients)





27305590 Shelton 2017 peer-reviewedpublication US 2004-2013 registryofre-transplantsinHIV+vs.HIV-patients47(37-57) 59.3 CKD4-5 nd nd nd HIV+re-KTxp HIV+retransplantationcandidates

HIV-re-KTxp HIV-retransplantationcandidatesHIV+/HCV+re-KTxp HIV/HCVcoinfectionretransplantationHIV+/HCV-re-KTxp HIV+retransplantationcandidatesHIV+re-KTxp HIV+retransplantationcandidates

HIV-re-KTxp HIV-retransplantationcandidatesHIV+/HCV+re-KTxp HIV/HCVcoinfectionretransplantationHIV+/HCV-re-KTxp HIV+retransplantationcandidates

KDIGO-TransplantCandidateGuidelineTopic:HIVCategoricaloutcomes

PMID Author Year

26765937 Roland 2016

25807035 Sawinski 2015

15153575 Abbott 2004

24621536 Malat 2014

Xia 2014



Samplesize(N) Eventrate,% Relativeeffect Variablesadjustedinmultivariateanalysis Pvalue OverallQuality

death(riskmatched) ND median4years 150 17(11.3%) HR1.172(0.669,2.055)recipientsex,ethnicity,ageattransplant,diabetes,hypertension,BMI,hetpatitisCantibody,hepatitisBcoreantibody,hepatitisBsurfaceantigen,CMVantibodystatus,workstatuseducation,andprimarymethodofpayment;humanleukocyteantigenmatch,coldischemictime,timeoftransplant;donorsec,ethnicity,age,diabetes,hypertension,andcauseofdeath

0.58

A

600

71(11.8%)

graftloss(risk-matched) ND

150

46(30.7%) HR1.418(0.997,2.017)recipientsex,ethnicity,ageattransplant,diabetes,hypertension,BMI,hetpatitisCantibody,hepatitisBcoreantibody,hepatitisBsurfaceantigen,CMVantibodystatus,workstatuseducation,andprimarymethodofpayment;humanleukocyteantigenmatch,coldischemictime,timeoftransplant;donorsec,ethnicity,age,diabetes,hypertension,andcauseofdeath

0.052

600

162(27.0%)

death 3years 492 11 aHR0.90(0.66,1.24) HCV+,age,sex,race,DM,pre-Txpdialysis,dialysisvintage,typeofdonor,donorHCV+,acuterejectionin1styear,CDChighriskdonor,antibodyinductionuse

0.53

A 117791 10

graftloss 3years 492 19 aHR0.60(0.40,0.88) HCV+,age,sex,race,DM,PRA>=30%,pre-Txpdialysis,typeofdonor,donorHCV+,acuterejectionin1styear,CDChighriskdonor,antibodyinductionuse

0.01

117791 14

death 2.62years 47 4.3 ND ND ND B2.99years 27851 12.8

5years aHR0.36(0.05,2.53) donorandrecipientage,race,gender,durationofdialysisbeforetransplantation,donorandrecipientHCVstatus,useofmycophenolateimmunosuppression,delayedgraftfunction,andbodymassindex

0.31

graftloss returntodialysisaftertransplantationanddidnotincludedeathwithafunctioninggraft

2.62years 47 2.1 ND ND ND

2.99years 27851 6.8

graftloss 1.92years 400 26.5 ND ND ND B1904 20.1

KidneyDonorRiskIndexasapredictorofgraftloss 1.92years aHR1.28(0.83,1.98) ND 0.27 aHR2.10(1.70,2.61) ND <0.001

graftloss death-censoredgraftsurvival 10years 243 ND ND ND 0.0928 A 243 ND

death-censoredgraftsurvival 3years 243 86.9 ND ND ND 243 86.4

multivariateHRadjustedforage,race,sex,DM,BMI,PRA,priortransplant,insurance,dialysisduration,transplantyear,comorbidity,HLAmismatch,andcoldischemiatime

3years aHR0.85(0.48,1.51) age,race,sex,DM,BMI,PRA,priortransplant,insurance,dialysisduration,transplantyear,comorbidity,HLAmismatch,andcoldischemiatime

ND

death survivalinmonths 10years 243 ND ND ND 0.4276243 ND

death 3years 243 85.1 ND ND ND243 89.6

multivariateHRadjustedforage,race,sex,DM,BMI,PRA,priortransplant,insurance,dialysisduration,transplantyear,comorbidity,HLAmismatch,andcoldischemiatime

3years 243 ND aHR0.80(0.39,1.64) age,race,sex,DM,BMI,PRA,priortransplant,insurance,dialysisduration,transplantyear,comorbidity,HLAmismatch,andcoldischemiatime

ND

PMID Author Year

25791727 Locke 2015

27305590 Shelton 2017



Samplesize(N) Eventrate,% Relativeeffect Variablesadjustedinmultivariateanalysis Pvalue OverallQuality

death 5years 467 16.5 ND ND 0.06 A Alsodatafor1and3years 4670 13.8

10years 467 48.4 HR1.34(1.08,1.68) ND 0.01 4670 27.9 5years 362 11.3 ND ND 0.5

3620 10.9 10years 362 36.5 HR1.26(0.98,1.69) ND 0.13

3620 22.4 5years 105 33 ND ND <0.01

1050 21.4 10years 105 70.7 HR1.57(1.11,2.23) ND 0.01

1050 43.77graftloss 5years 467 30.8 ND ND 0.003

4670 24.7

10years 467 50.2 HR1.37(1.15,1.64) ND <0.001 4670 45.6 5years 362 25 ND ND 0.58

3620

24.2

10years 362 44.1 HR1.06(0.85,1.33) ND 0.61

362044

5years 105 48 ND ND 0.02

1050

36

10years 105 73 HR1.38(1.08,1.77) ND 0.01

105063.8

graftloss nd 3years 22 33.3 HR1.96(1.14,3.36) recipientage,race,HIVstatus,HCVstatus;donorage,race,type;timeframebetweenfirstgraftlossandre-KTxp;anderaofre-KTxp(2004-2007vs.2008-2013)

0.01

A4127 17.37 85.7 HR5.40(1.3,21.84) nd nd13 15.4

death nd 3years 22 19.8 HR3.11(1.82,5.34) recipientage,race,HIVstatus,HCVstatus;donorage,race,type;timeframebetweenfirstgraftlossandre-KTxp;anderaofre-KTxp(2004-2007vs.2008-2013)

<0.01

4127 7.97 42.9 HR1.21(0.30,4.90) nd nd13 15.4

KDIGO-TransplantCandidateGuidelineTopic:HIVQualityAssessment


PMID Author Year



















nodescription

26765937 Roland 2016 NA NA NA NA NA low25807035 Sawinski 2015 NA NA NA NA NA low15153575 Abbott 2004 NA NA NA NA NA low

24621536 Malat 2014 NA NA NA NA NA low,although5xasmanycontrolswereenrolledversuscases.0 Xia 2014 NA NA NA NA NA low25791727 Locke 2015 NA NA NA NA NA low27305590 Shelton 2017 NA NA NA NA NA low

KDIGO-TransplantCandidateGuidelineTopic:HIVQualityAssessment

PMID Author Year

26765937 Roland 201625807035 Sawinski 201515153575 Abbott 2004

24621536 Malat 20140 Xia 201425791727 Locke 201527305590 Shelton 2017






yes;no;unclear










extracteddata.



low low low unclear low nonelow low unclear low low nonelow low NA unclear low none

low lowhigh,therewassignificantdifferencebetweenfollow-uptimesforthecasesversuscontrols. unclear low none

low low low unclear low nonelow low low unclear low nonelow low low unclear low none

Evidence Profile Guideline: Transplantation outcomes in patients with HIV


Total N of Patients







for Outcome


Outcome

Death 6 1421 HIV+ (155282

HIV-)

Serious limitations

(-1)* Important

inconsistencies (-1)

Direct (0)

Imprecise estimates (-1)

Very low Studies inconsistent about risk of death among HIV+ vs. HIV- with HR ranging from 0.36 to 3.11

Critical

Graft loss

7 1821 HIV+ (157186

HIV-)

Serious limitations

(-1)* Important

inconsistencies (-2)†

Direct (0)

None Very low Studies inconsistent about risk of graft loss among HIV+ vs. HIV- with HR ranging from 0.60 to 1.96

Critical

Overall summary: Unclear whether HIV status associated with post-transplantation death or graft loss.


Studies included in EP: PMID 26765937; PMID 25807035; PMID 15153575; PMID 24621536; PMID 25098499; PMID 25791727; PMID 27305590 Abbreviations: HIV = human immunodeficiency virus, HR = hazard ratio. * It is unknown whether results were based on multivariate analysis (and the covariates). Some studies have relatively short length of follow-up (shorter than three years in two studies for each outcome respectively).

KDIGO-TransplantCandidateGuidelineTopic:HBVTreatmentCategoricaloutcomes




%MaleBaselineCKD

stageBaselinekidney

functionArm(Intervention) Interventiondescription Interventionnotes Interventionduration

15637753 Lapinski 2005 peer-reviewedjournal Poland <=2004 unclear [35-66] 75% CKD5 HD Lamivudine 100mgaftereachdialysis(3times/wk) 12months

24997462 Ow 2014 peer-reviewedjournal UnitedKingdom 2000-2008 retrospective

51[IQR43-59]

69% CKD5 HD Lamivudine firstdose35mgthen10mgoncedaily Lamivudineresistancedevelopedinfivepatients—twowereswitchedtoadefovir;threewerechangedtocombinationlamivudineandadefovir.

58months,median(IQR37-81)

Lamivudine firstdose35mgthen10mgoncedaily Lamivudineresistancedevelopedinfivepatients—twowereswitchedtoadefovir;threewerechangedtocombinationlamivudineandadefovir.

58months,median(IQR37-81)

Notreatment

KDIGO-TransplantCandidateGuidelineTopic:HBVTreatmentCategoricaloutcomes

PMID Author Year

15637753 Lapinski 2005

24997462 Ow 2014

Outcome DefinitionOutcomemeasurement

timepointSamplesize(N)

Frequency(event)rate,%


eliminationofHBV-DNA theabsenceofHBsantigensdetectedinsera 12monthsaftertreatment 16 56% NA NA BeliminationofHBeAg theabsenceofHBeantigensinsera 12monthsaftertreatment 16 38% NA NA

completeviralsupression <12IU/mL 122.4months 21(0atbaseline) 48% +48%c/tbaseline NA C

viralsupression 1.2-9.9x10^1 21(0atbaseline) 10% +10%c/tbaselineviralsupression 1.0x10^2-9.9x10^3 21(2atbaseline) 29% +19%c/tbaselineviralsupression 1.0x10^4x9.9x10^6 21(14atbaseline) 14% -52%c/tbaselineviralsupression >=1.0x10^7 21(5atbaseline) 0% -24%c/tbaselineDeath,allcause 122.4months 21 29%(6) nd nd Causeofdeath:Inpatientswithcomplete

suppression,twodeathsoccurredduetonon-hepaticcauses(onedialysiswithdrawal,onesepsis).Inpatientswithincompletesuppression,thereweretwoliver-relateddeaths(HCC,spontaneousbacterialperitonitis)andtwodeathsduetodialysiswithdrawal.

31 45%(14) Causeofdeath:sepsis(fivecases),dialysiswithdrawal(fourcases),cardiac(twocases),non-hepaticmalignancy(twocases)andhepatocellularcarcinoma(HCC;onecase).

KDIGO-TransplantCandidateGuidelineTopic:HBVTreatmentQualityAssessment


PMID Author Year





















15637753 Lapinski 2005 nd nd nd nd nd notrepresentative nodescription

24997462 Ow 2014 nd nd nd nd nd notrepresentative nodescription

KDIGO-TransplantCandidateGuidelineTopic:HBVTreatmentQualityAssessment

PMID Author Year

15637753 Lapinski 2005

24997462 Ow 2014

















extracteddata.



securerecord no nd nd low low 8(50%)ofthesubjectswerecoinfectedwithHCV

securerecord no nd nd low low

Lamivudineresistancedevelopedin5patients—2wereswitchedtoadefovir;3werechangedto

combinationlamivudineandadefovir.

Evidence Profile Guideline: Hepatitis B treatment (lamivudine)


Total N of Patients







for Outcome


Outcome

Death, all-cause


(-2)

N/A Direct (0)

Sparse (-1)

Very low 45% (no treatment) vs. 29% (treatment), NS Critical

Death, hepatic


(-2)

N/A Direct (0)

Sparse (-1)

Very low 3% (no treatment; HCC) vs. 10% (treatment; HCC, spontaneous bacterial peritonitis), NS

High

Viral elimination / suppression


(-2)


(0)

Direct (0)

Small studies (-1)

Very low HBV DNA elimination 56% (12 mo), HBeAg elimination 38% (12 mo), complete viral suppression 48% (10 y)

High

Overall summary: Lamivudine results in long-term viral elimination in about 50% of patients on HD. Lower death and hepatic-death

rate with treatment, but underpowered to show statistical significance.


Studies included in EP: PMID 15637753; PMID 24997462

KDIGO-TransplantCandidateGuidelineTopic:CancerScreeningCategoricaloutcomes



Age[mean{SD}ormedian

(range)]%Male

BaselineCKDstage


Arm(Intervention)Interventiondescription

8116110 Yang 1994 peer-reviewedjournal US 1990-1991 prospectivecohortstudy mean43(50-68) 61 CKD5 HD renalultrasonography(RUS)cystoscopicexaminationdigitalrectalexamination

9884257 Gulanikar 1998 peer-reviewedjournal US 1995-1997 prospectivecohortstudy 35{2.4} 62 CKD5 HD renalultrasound

26069893 AlAmeel 2015 peer-reviewedjournal SaudiArabia 2008-2014 retrospectivecohortstudy mean57.9(50-74) 61 CKD5 HD colonoscopy

25247014 Therrien 2014 peer-reviewedjournal Canada 2007-2009 retrospectivecohortstudy 55.6{8.7} 75 CKD5 HD colonoscopy

KDIGO-TransplantCandidateGuidelineTopic:CancerScreeningCategoricaloutcomes

PMID Author Year

8116110 Yang 1994

9884257 Gulanikar 1998

26069893 AlAmeel 2015

25247014 Therrien 2014

Outcome Definition Samplesize(N)Frequency


Renalcellcarcinoma 100 1% ND ND CBladdertransitionalcellcarcinoma 100 1% ND NDProstatecancer 100 1% ND ND

renalcellcarcinoma 206 4% ND ND B

colorectalcancer 1polyp 169 15% ND ND B2polyps 169 5% ND ND3polyps 169 2% ND ND>4polyps 169 2% ND ND

colorectalcancer 1polyp 64 13% ND ND B≥2polyps 64 20% ND ND


GuidelineTopic:Cancerscreening

QualityAssessment


PMID Author Year















































nodescription



nodescription

8116110 Yang 1994 NA NA NA NA NA low low9884257 Gulanikar 1998 NA NA NA NA NA low unclear26069893 AlAmeel 2015 NA NA NA NA NA low low25247014 Therrien 2014 NA NA NA NA NA low low


GuidelineTopic:Cancerscreening

QualityAssessment

PMID Author Year

8116110 Yang 19949884257 Gulanikar 199826069893 AlAmeel 201525247014 Therrien 2014




accountedfor







nodescription

yes;no;unclear














bias


















extracteddata.







low no,butsincethisisascreeningstudytheriskofbiasislow NA NA low low nonelow no,butsincethisisascreeningstudytheriskofbiasislow NA NA low low ACKDvsnon-ACKDreportedresultslow no,butsincethisisascreeningstudytheriskofbiasislow NA NA low low nonelow no,butsincethisisascreeningstudytheriskofbiasislow NA NA low low none

Evidence Profile Guideline: Cancer screening in kidney transplant candidates

Screening Test

(Outcome)

# of Studies

Total N of

Patients



Directness of the Evidence



Evidence for Outcome

Description of Findings Importance of Outcome

Colonoscopy (Colon cancer)


(-1)


(0)

Indirect (-1)*

Sparse (-1)

Very low Pretransplant screening by colonoscopy found at least one polyp in 22%-33% of kidney transplant candidates.

High

Ultra-sonography (Renal cell carcinoma)


(-2)


(0)

Indirect (-1)*

Sparse, old (-2)

Very low Pretransplant screening by kidney ultrasonography found abnormalities consistent with renal cell carcinoma in 5% of kidney transplant candidates.

High

Cystoscopy (Transitional cell carcinoma)


(-2)

N/A Indirect (-1)*

Sparse, old (-2)

Very low Pretransplant screening by cystoscopic examination found stage TA transitional cell carcinoma of the bladder in 1% of kidney transplant candidates.

High

Digital Rectal Exam (Prostate cancer)


(-2)

N/A Indirect (-1)*

Sparse, old (-2)

Very low Pretransplant screening by digital rectal exam found stage A prostate cancer in 1% of kidney transplant candidates.

High

Overall summary: Screening kidney transplant candidates for cancer found cancer and pre-cancer in a percentage of patients.


Studies included in EP: PMID 8116110; PMID 9884257; PMID 26069893; PMID 25247014 * All studies evaluated only incidence of positive screening test results with no clinical outcomes and no outcomes related to transplantation.

KDIGO-TransplantCandidateGuidelineTopic:ProstatectomyCategoricaloutcomes


BaselineCKDstage Baselinekidneyfunction

Mean/medianPSArate(ng/mL)

D'Amicoclassification

Arm(Intervention)

25374252 Tillou 2014 peer-reviewpublication France 2003-2013 retrospectivedatabaseanalysis(1center)

AtPCdiagnosis:61.8{6.6}(51.4-69) CKD4-5 ND mean8.5{4} low:10intermediate:9high:0

prostatectomy

2016 abstract(updateofTillou2014) retrospectivedatabaseanalysis(10centers)

MedianatPCdiagnosis:59.8 CKD4-5 ND median7 low:27intermediate:24high:1

prostatectomy

26757719 Beyer 2016 peer-reviewpublication Germany 1992-2013 retrospectivedatabaseanalysis(1center)

Median:64.5(59.3-69.5) ND ND median6.1(3.9-9.7)ND prostatectomy

KDIGO-TransplantCandidateGuidelineTopic:ProstatectomyCategoricaloutcomes

PMID Author Year

25374252 Tillou 2014

2016

26757719 Beyer 2016

Interventiondescription Outcome Definition OutcomeMeasurementTimepoint

Samplesize(N)

Frequency(Event)Rate,%


Twoseniorsurgeonsperformedallradicalprostatectomies

prostatecancerrecurrence ND mean44.3{24.6}months 19 (0)0% NA NA A

RadicalProstatectomy:28retropubic,15laparoscopicand3byaperinealapproach.18patientshadalymphnodedissection

prostatecancerrecurrence ND median36months 43 (0)0% NA NA

RadicalProstatectomy;Pelviclymphnodedissectionwasperformedinintermediate-andhigh-riskpatientsaccordingtoD’Amicoriskclassifcation.

cancer-specificdeath ND median24.7months 20 (0)0% NA NA B

deaths ND median24.7months 20 2(10%) NA NA


GuidelineTopic:Prostatectomy

QualityAssessment

RCT:Adequategenerationofarandomizedsequence RCT:.....Allocationconcealment RCT:.....BlindingofPATIENTS RCT:.....BlindingofPROVIDERS RCT.....Intention-to-treat-analysis NonRCT…..Selectionoftreatmentandcontrolcohort

PMID Author Year













































drawnfromthesamesource;drawnfromadifferentsource;

OR

nodescription

25374252 Tillou 2014;2016 NA NA NA NA NA NA26757719 Beyer 2016 NA NA NA NA NA NA


GuidelineTopic:Prostatectomy

QualityAssessment

PMID Author Year

25374252 Tillou 2014;201626757719 Beyer 2016

NonRCT…..Demonstrationthatoutcomeofinterestwasnot



accountedfor





yes;no;unclear














bias


















extracteddata.







low NA NA low low nonelow NA NA unclear low none

Evidence Profile Guideline: Prostatectomy in patients with prostate cancer


Total N of Patients







for Outcome


Outcome


(-1)

N/A Direct (0)

Sparse, small (-2)

Very low The rate of death after 2 years of follow-up was 10%. None of the deaths were cancer related.

Critical

Prostate cancer recurrence

1 43 No limitations (-0)

N/A Direct (0)

Sparse, small (-2)

Low Prostate cancer did not recur over the period of 3.7 years.

High

Overall summary: Prostatectomy during transplantation prevents cancer recurrence.


Studies included in EP: PMID 25374252; PMID 26757719

KDIGO-TransplantCandidateGuidelineTopic:TreatmentofactivecancerCategoricaloutcomes




Typeofcancer Arm(Intervention) Interventiondescription

9422410 Goldfarb 1997 peer-reviewedpublication USandEU 1974-1996 retrospectivecohortstudy 36{9.6} 72 CKD4-5 ND renalcellcarcinoma removaloflocalizedrenalcellcarcinoma

patientswhohadVonHippel-Lindaudiseaserenderedanephricduetotheremovaloflocalizedrenalcellcarcinomaandwhosubsequentlyunderwentrenaltransplantation.Thirteenpatientsunderwentbilateralnephrectomy(5synchronousand8asynchronous),whereas5patientsunderwentnephron-sparingsurgeryfollowedbyremnantnephrectomyfortumorrecurrence

NoRCC(orVHL) renaltransplantrecipientswithoutVHLremovaloflocalizedrenalcellcarcinoma








9869873 Penn 1997 peer-reviewedpublication US untilAugust1997 retrospectivecohortstudy ND ND ND ND incidentalrenalcarcinoma:72 treatmentofincidentalrenalcellcarcinoma

treatmentofrenalcellcarcinomapre-transplant,atthetimeoftransplant,oraftertransplant(n=99)

carcinomaofthebodyoftheuterus:26 treatmentofcarcinomaofthebodyoftheuterus

treatmentofcarcinomaofthebodyoftheuteruspre-transplant,atthetimeoftransplant,oraftertransplant(n=99)

testiculartumors:43 treatmentoftesticulartumors

treatmentoftesticulartumorspre-transplant,atthetimeoftransplant,oraftertransplant(n=99)

carcinomaofuterinecervix:93 treatmentofcarcinomaoftheuterus

treatmentofcarcinomaoftheuteruspre-transplant,atthetimeoftransplant,oraftertransplant(n=99)





carcinomaofthethyroidgland:54 treatmentofcarcinomaofthethyroidgland

treatmentofcarcinomaofthethyroidglandpre-transplant,atthetimeoftransplant,oraftertransplant(n=99)

lymphomas:37 treatmentoflymphomas

treatmentoflymphomaspre-transplant,atthetimeoftransplant,oraftertransplant(n=99)

Wilms'tumor:78 treatmentofWilms'tumors

treatmentofWilms'tumorspre-transplant,atthetimeoftransplant,oraftertransplant(n=99)

carcinomaoftheprostategland:33 treatmentofcarcinomaoftheprostategland

treatmentofcarcinomaoftheprostateglandpre-transplant,atthetimeoftransplant,oraftertransplant(n=99)

colorectalcarcinoma:53 treatmentofcolorectalcancers

treatmentofcolorectalcancerpre-transplant,atthetimeoftransplant,oraftertransplant(n=99)

melanoma:29 treatmentofskincancers

treatmentofskincancerpre-transplant,atthetimeoftransplant,oraftertransplant(n=99)

carcinomaofthebreast:90 treatmentofcarcinomaofthebreastcancers

treatmentofcarcinomaofthebreastpre-transplant,atthetimeoftransplant,oraftertransplant(n=99)

othersymptomaticrenalcarcinoma:222 treatmentofothersymptomaticrenalcarcinoma

treatmentofothersymptomaticrenalcarcinomapre-transplant,atthetimeoftransplant,oraftertransplant(n=99)

carcinomaoftheurinarybladder:55 treatmentofcarcinomaodtheurinarybladder

treatmentofcarcinomaoftheurinarybladderpre-transplant,atthetimeoftransplant,oraftertransplant(n=99)

sarcomas:17 treatmentofsarcomas treatmentofsarcomaspre-transplant,atthetimeoftransplant,oraftertransplant(n=99)





non-melanomaskincancer:125 treatmentofskincancer

treatmentofskincancerpre-transplant,atthetimeoftransplant,oraftertransplant(n=99)

myelomas:12 treatmentofmyelomas treatmentofmyelomapre-transplant,atthetimeoftransplant,oraftertransplant(n=99)

KDIGO-TransplantCandidateGuidelineTopic:TreatmentofactivecancerCategoricaloutcomes

PMID Author Year

9422410 Goldfarb 1997

9869873 Penn 1997

InterventionDuration



Note Relativeeffect Pvalue OverallQuality

NA graftsurvival ND 1year 32 (32)100% ND 0.52 B

NA 32 87.5% NDNA 5years 32 62.6% ND 0.52

NA 32 76.1% NDNA patientsurvival ND 1year 32 (32)100% ND 0.37

NA 32 96.8% NDNA 5years 32 65.0% ND 0.37

NA 32 93.0% NDNA death,cancer-related deathsfrommetastaticdisease 5years 32 (3)9.3% ND ND

ND cancerrecurrence incidentalrenal ND 72 1% lowrecurrencerate(1-7%)tumors

ND ND C

ND treated>5yearsprettransplant,%ofrecurrentpatients

ND ND -- ND ND

ND cancerrecurrence bodyofuterus ND 26 4% lowrecurrencerate(1-7%)tumors

ND ND


ND ND 50% ND ND

ND cancerrecurrence testicular ND 43 5% lowrecurrencerate(1-7%)tumors

ND ND


ND ND 58% ND ND

ND cancerrecurrence cervixiftheuterus ND 93 6% lowrecurrencerate(1-7%)tumors

ND ND

PMID Author Year InterventionDuration





ND ND 54% ND ND

ND cancerrecurrence thyroid ND 54 7% lowrecurrencerate(1-7%)tumors

ND ND


ND ND 35% ND ND

ND cancerrecurrence lymphoma,Hodgkinsdiseaseandnon-Hodgkinslymphoma

ND 37 11% intermediaterecurrencerate(11-21%)tumors

ND ND


ND ND 76% ND ND

ND cancerrecurrence Wilms'tumor ND 78 13% intermediaterecurrencerate(11-21%)tumors

ND ND


ND ND 33% ND ND

ND cancerrecurrence prostate ND 33 18% intermediaterecurrencerate(11-21%)tumors

ND ND


ND ND insufficient ND ND

ND cancerrecurrence colon ND 53 21% intermediaterecurrencerate(11-21%)tumors

ND ND


ND ND 42% ND ND

ND cancerrecurrence melanoma ND 29 21% intermediaterecurrencerate(11-21%)tumors

ND ND


ND ND 41% ND ND

ND cancerrecurrence breast ND 90 23% highrecurrencerate(>23%)tumors

ND ND


ND ND 51% ND ND

ND cancerrecurrence symptomaticrenalcarcinomas ND 222 27% highrecurrencerate(>23%)tumors

ND ND


ND ND 22% ND ND

ND cancerrecurrence bladder ND 55 29% highrecurrencerate(>23%)tumors

ND ND


ND ND 22% ND ND

ND cancerrecurrence sarcomas ND 17 29% highrecurrencerate(>23%)tumors

ND ND

PMID Author Year InterventionDuration





ND ND insufficient ND ND

ND cancerrecurrence nonmelanomaskincarcinomas ND 125 53% highrecurrencerate(>23%)tumors

ND ND


ND ND 11% ND ND

ND cancerrecurrence myeloma ND 12 67% highrecurrencerate(>23%)tumors

ND ND


ND ND 0% ND ND

KDIGO-TransplantCandidateGuidelineTopic:TreatmentofactivecancerQualityAssessment


PMID Author Year



















nodescription

9869873 Penn 1997 NA NA NA NA NA NA8475546 Penn 1993 NA NA NA NA NA NA

9422410 Goldfarb 1997 NA NA NA NA NA NA

KDIGO-TransplantCandidateGuidelineTopic:TreatmentofactivecancerQualityAssessment

PMID Author Year

9869873 Penn 19978475546 Penn 1993

9422410 Goldfarb 1997






yes;no;unclear










extracteddata.



low NA NA unclear unclear high,nodescriptionofmethodslow NA NA unclear low none

low unclearmoderate,forpatientsurvivalcontrolgrouphadalongerfollow-upthandiseasegroup unclear low notsurethesearetrulycancerpatientsgoingintotransplant

Evidence Profile Guideline: Pretransplant cancer treatment

Outcome (Treated Cancer)*

# of Studies

Total N of Patients







for Outcome


Outcome

Death (RCC) 1 64 Serious limitations

(-1)

N/A Direct (0)

Sparse, small (-2)

Very low Similar death rates post-transplantation in patients with VHL treated for RCC as patients without RCC. Cancer-related death in 9% of patients treated for RCC

Critical

Graft loss (RCC)


(-1)

N/A Direct (0)

Sparse, small (-2)

Very low Similar graft loss rates post-transplantation in patients with VHL treated for RCC as patients without RCC.

Critical

Cancer recurrence (multiple)


(-2)

N/A Direct (0)

Sparse (-1)

Very low Low recurrence cancers (1-7%): RCC, uterus, testicular, cervix, thyroid. Intermediate recurrence cancers (11-21%): lymphoma, Wilm’s tumor, prostate, colorectal, melanoma. High recurrence cancers (>23%): breast, other renal, bladder, sarcoma, non-melanoma skin, myeloma

High

Overall summary: Patients treated for RCC (with VHL) have similar post-transplant death and graft loss rates as patients without

RCC. Cancers have different frequencies of recurrence.


Studies included in EP: PMID 9422410; PMID 9869873 Abbreviations: RCC = renal cell carcinoma, VHL = Von Hippel-Lindau disease. * Treatment pre-transplantation

KDIGO-TransplantCandidateGuidelineTopic:CABGCategoricaloutcomes



%MaleBaselineCKD

stageBaselinekidneyfunction

Coronaryarterydisease

Valvulardisease Arm(Intervention) Interventiondescription

18154800 Bechtel 2008 peer-reviewedpublicationGermany 1989-2003 retrospectivemulticenterstudy 61{11} 69.5 CKD5D SCr568{229}mmol/L 100%(ofanalyzed) 192(36.8%) CABGwithsubsequenttxp Coronaryarterybypassgrafting,eitherwith(n=103)orwithout(n=326)valvesurgery.

CABGwithoutsubsequenttxp

KDIGO-TransplantCandidateGuidelineTopic:CABGCategoricaloutcomes

PMID Author Year

18154800 Bechtel 2008



Samplesize(N)Frequency(Event)

Rate,%Relativeeffect Pvalue OverallQuality

Patientsurvival Multivariateanalysisoflong-termsurvivalwithasubsequentrenaltransplant(afterexclusionofallperioperativedeaths)-adjustedforemergencysurgery,DM,age,numberofallogenictransfusions,useofinternalthoracicarterygraft,sinusrhythm

5years 17 93.8%(81.9,100) Death:HR0.14(0.03,0.58) 0.007

B5years 412 39.4%(34.0,44.7)


GuidelineTopic:CABG

QualityAssessment


PMID Author Year














































nodescription

18154800 Bechtel 2008 NA NA NA NA NA low,howeveronly17ofthe552patientsreceivedsubsequenttransplant


GuidelineTopic:CABG

QualityAssessment

PMID Author Year

18154800 Bechtel 2008




accountedfor





yes;no;unclear














bias


















extracteddata.







low unclear low unclear low,94.3%completenessoff/up none

Evidence Profile Guideline: Cardiac revascularization pre-transplantation


Total N of Patients







for Outcome


Outcome


(-1)

N/A Direct (0)

Sparse (-1)

Low Among dialysis patients who had CABG, those who had subsequent kidney transplantation had better survival than those who did not; HR = 0.14 (95% CI 0.03, 0.58)

Critical

Overall summary: Patients who have kidney transplant after CABG have higher survival than those who do not receive a transplant


Studies include in EP: PMID 18154800 Abbreviations: CI = confidence interval, HR = hazard ratio.

KDIGO-TransplantCandidateGuidelineTopic:EchocardiographyCategoricaloutcomes

PMID Author Year Typeofarticle Country Era StudydesignAge[mean{SD}ormedian(range)]


Baselinekidneyfunction LVfunction Arm(Intervention) Interventiondescription

11472607 Mitsnefes 2001 peer-reviewedpublication US 1998-2000 prospectiveobservationalstudy 15.4{5.1}{5.9,20.8)

57

CKD5D

GFR55.0{21.4}mL/min/1.73m2(41,121)

LVEDD:4.24±0.69cmLVPW:0.77±0.24cmLVSF:37.10%±8.3LVM:110.50±55.2gmLVMindex:43.90±17.8gm/m2.7LVH:12(53%)LVgeometry:concentricLVH:5(22%)eccentricLVH:7(30%)concentricremodeling:2(9%)normal:9(39%)

Echocardiography Eachpatienthadtwocompleteechocardiographicevaluations.ThefirstwasperformedaftertheinitialdiagnosisofESRDbutafteratleast6weeksofchronicdialysis.Thesecondechocardiographicevaluationwasperformedatleast6monthsaftersuccessful(i.e.measuredGFRatleast40mL/min/1.73m2)renalTx

23542473 Stallworthy 2013 peer-reviewedpublication NewZealand 2000-2009 retrospectiveobservationalstudy 53(42,61) 64 CKD4-5 ND

SubjectiveLVfunction:Normal:613(86%)Mildlyimpaired:57(8%)Moderatelyimpaired:30(4%)Severelyimpaired:17(2%)

Echocardiography Thelastechocardiogrambeforetransplantationorthemostrecentechocardiogram(forindividualsnottransplanted)wasanalyzedasrepresentingthemostrelevantdataavailabletothetransplantingphysician

PMID Author Year Typeofarticle Country Era StudydesignAge[mean{SD}ormedian(range)]


Baselinekidneyfunction LVfunction Arm(Intervention) Interventiondescription

7491692 Parfrey 1995 peer-reviewedpublication Canada 1982-1991 prospectivecohort 37{12} 72 CKD4-5 ND Leftatrialdiameter:39±6mmLVenddiastolicdiameter:52±7mmLVendsystolicdiameter:34±7mmVentricularseptalwallthicknessindiastole:12.2±3PosteriorLVwallthicknessindiastole:12.1(2.5)Fractionalshortening:35%±8.5LVmassindex:152±50g/m2LVvolume:84±35mL/m2Diagnosis:concentricLVhypertrophy:41(41%)LVdilation:32(32%)systolicdysfunction:12(12%)normalechocardiogram:17(17%)

Echocardiography baselineandannualechocardiographywereperformedusingM-modeandtwo-dimensionalultrasonography.

24009216 Kainz 2013

peer-reviewedpublication

Austria 1992-2001 registrystudy 52{13} 58 CKD5D 6.8{2.8} LVEDD:48{6}mmLVESD:29{6}mmLVF(<50%):4%

Echocardiography Standardtwo-dimensionalechocardiographicandM-modepictureswereperformedbyacardiologistusingeitheraVividiorVivid7CardiovascularUltrasoundSystem

26750652

Bang 2016

peer-reviewedpublication

SouthKorea 2006-2013 retrospectiveobservational 44.4{11.3} 63 ND eGFR7(5-9) 60.4{6.5} Echocardiography preoperativeechocardiography,E/ecalculated

27841080 Ozkul 2016 peer-reviewedpublication Turkey 2004-2014 retrospectiveobservational ~38{nd} 68.2 ND ND n=162<55%,n=1601>=55% Echocardiography

KDIGO-TransplantCandidateGuidelineTopic:EchocardiographyCategoricaloutcomes

PMID Author Year

11472607 Mitsnefes 2001

23542473 Stallworthy 2013

Predictor Definition Outcome DefinitionOutcomeMeasurementTimepoint

Samplesize(N)Frequency(Event)Rate,%


LVfunction leftventricularhypertrophy(LVH) baseline 23 (12)52% ND ref

A1.9yearposttransplant 23 (13)56% ND NS

concentricLVH baseline 23 (5)22% ND ref1.9yearposttransplant 23 (4)17% ND NS

eccentricLVH baseline 23 (7)30% ND ref1.9yearposttransplant 23 (9)39% ND NS

concentricremodeling baseline 23 (2)9% ND ref1.9yearposttransplant 23 (2)9% ND NS

normal baseline 23 (9)39% ND ref1.9yearposttransplant 23 (8)35% ND NS

(allpatients) all-causedeath 4.2years 739 (217)29% ND ND

ALVEF per5%increase,univariate 4.2years 739 ND 0.84(0.79,0.89) <0.001LVESD per5%increase,univariate 4.2years 739 ND 1.21(1.09,1.36) <0.001LVEDD per5%increase,univariate 4.2years 739 ND 1.14(1.02,1.28) 0.02FS per5%increase,univariate 4.2years 739 ND 0.82(0.72,0.94) 0.004

Mildimpairment

Perechoreading,adjustedforage,dialysisduration,DM,waitlistingstatus,subjectiveLVfunction,PHT/RVD,RWMA

4.2years 739 ND 1.14(0.70,1.85) 0.61

Moderateimpairment


4.2years 739 ND 1.36(0.71,2.59) 0.35

Severeimpairment


4.2years 739 ND 2.71(1.36,5.39) 0.005

Pulmonaryhypertension/rightventriculardysfunction


4.2years 739 ND 1.91(1.28,2.83) 0.001

Regionalwallmotionabnormalities


4.2years 739 ND 1.95(1.32,2.88) <0.001

(allpatients) cardiovasculardeath 4.2years 739 (98)13% ND NDLVEF per5%increase,univariate 4.2years 739 ND 0.83(0.77,0.90) <0.001LVESD per5%increase,univariate 4.2years 739 ND 1.25(1.07,1.47) 0.006LVEDD per5%increase,univariate 4.2years 739 ND 1.13(0.95,1.34) 0.17FS per5%increase,univariate 4.2years 739 ND 0.8(0.65,0.99) 0.04

PMID Author Year

7491692 Parfrey 1995

24009216 Kainz 2013

26750652

Bang 2016

27841080 Ozkul 2016

Predictor Definition Outcome DefinitionOutcomeMeasurementTimepoint



Mildimpairment


4.2years 739 ND 1.47(0.73,2.95) 0.28

Moderateimpairment


4.2years 739 ND 1.26(0.47,3.39) 0.65

Severeimpairment


4.2years 739 ND 4.60(1.66,12.72) 0.003

Pulmonaryhypertension/rightventriculardysfunction


4.2years 739 ND 1.45(0.76,2.74) 0.26

Regionalwallmotionabnormalities


4.2years 739 ND 2.30(1.31,4.04) 0.004

LVfunction concentricLVhypertrophy baseline 102 (41)41% ND ref

A47months 102 (37)37% ND NS

LVdilation baseline 102 (32)32% ND ref47months 102 (29)29% ND NS

systolicdysfunction baseline 102 (12)12% ND ref47months 102 (0)0% ND 0.001

normalechocardiogram baseline 102 (17)17% ND ref47months 102 (36)36% ND 0.004

LAD >53mm Death 10years 287 33.60% ND ND

A≤53mm 10years 266 16.30% ND NDpermm,adjustedforRVD,PVD,HBG,immunosuppression,calcineurininhibitoruse,atrialfibrillation

10years ND ND HR1.06(.03,1.08) <0.001

RVD

permm,adjustedforLAD,PVD,HBG,immunosuppression,calcineurininhibitoruse,atrialfibrillation

10years ND ND HR0.95(0.90,1.01) 0.12

RAD permm,adjustedforHBG,cerebroVD,PVD,age,donorfactors,immunosupporession,calcineurininhibitoruse,CHD,year

Graftloss 10years ND ND HR1.04(1.02,1.07) 0.001

E/e'<15

Earlydiastolictransmitralflowvelocity(E)incombinationwithearlydiastolicmitralannularvelocity(e') Graftfailure 3.4years 821

ND

E/e'>=15>=15isindicativeofanincreaseinLVfillingpressure 3.4years 224

NDOR1.51(1.02-2.23) 0.039

E/e'<15 postTxphemodialysis 3.4years 821 NDE/e'>=15 3.4years 224 ND OR1.69(1.05-2.73) 0.032E/e'<15 Mortality,overall 3.4years 821 NDE/e'>=15 3.4years 224 ND OR3.38(1.78-6.48) <0.001LVEF<55% Death ~10years 162 6.8% ND

PMID Author Year Predictor Definition Outcome DefinitionOutcomeMeasurementTimepoint



LVEF>=55% ~10years 1601 2% ND <0.001LVEF<55% Survivaltime,median 114.1months 162LVEF>=55% 123.5months 1601 0.002

KDIGO-TransplantCandidateGuidelineTopic:EchocardiographyContinuousoutcomes



%MaleBaselineCKD

stageBaselinekidney

functionLVfunction Arm(Intervention)

11472607 Mitsnefes 2001 peer-reviewedpublication US 1998-2000 prospectiveobservationalstudy 15.4{5.1}{5.9,20.8) 57

CKD5D

GFR55.0{21.4}mL/min/1.73m2(41,121)

LVEDD:4.24±0.69cmIVS:0.80±0.18cmLVPW:0.77±0.24cmLVSF:37.10%±8.3LVM:110.50±55.2gmLVMindex:43.90±17.8gm/m2.7LVH:12(53%)LVgeometry:concentricLVH:5(22%)eccentricLVH:7(30%)concentricremodeling:2(9%)normal:9(39%)

Echocardiography

23542473 Stallworthy 2013 peer-reviewedpublication NewZealand 2000-2009 retrospectiveobservationalstudy 53(42,61) 64 CKD4-5 ND

SubjectiveLVfunction:Normal:613(86%)Mildlyimpaired:57(8%)Moderatelyimpaired:30(4%)Severelyimpaired:17(2%)

Echocardiography

7491692 Parfrey 1995 peer-reviewedpublication Canada 1982-1991 prospectivecohort 37{12} 72 CKD4-5 ND Leftatrialdiameter:39±6mmLVenddiastolicdiameter:52±7mmLVendsystolicdiameter:34±7mmVentricularseptalwallthicknessindiastole:12.2±3PosteriorLVwallthicknessindiastole:12.1(2.5)Fractionalshortening:35%±8.5LVmassindex:152±50g/m2LVvolume:84±35mL/m2Diagnosis:concentricLVhypertrophy:41(41%)LVdilation:32(32%)systolicdysfunction:12(12%)normalechocardiogram:17(17%)

Echocardiography

KDIGO-TransplantCandidateGuidelineTopic:EchocardiographyContinuousoutcomes

PMID Author Year

11472607 Mitsnefes 2001

23542473 Stallworthy 2013

7491692 Parfrey 1995

Interventiondescription Outcome DefinitionOutcomeMeasurement

TimepointSamplesize(N) BaselineValue FinalValue Change Pvalue OverallQuality

Eachpatienthadtwocompleteechocardiographicevaluations.ThefirstwasperformedaftertheinitialdiagnosisofESRDbutafteratleast6weeksofchronicdialysis.Thesecondechocardiographicevaluationwasperformedatleast6monthsaftersuccessful(i.e.measuredGFRatleast40mL/min/1.73m2)renalTx

LVEDD left-ventricularend-diastolicdimensionincm 1.9yearposttransplant 23 4.24 4.46 0.22 0.07 A

IVS interventricularend-diastolicthicknessincm 1.9yearposttransplant 23 0.8 0.84 0.04 0.31LVPW leftventricularend-diastolicposteriorwall

thicknessincm1.9yearposttransplant 23 0.77 0.72 -0.05 0.36

LVSF %,leftventricularshorteningfunction 1.9yearposttransplant 23 37.1 41.8 4.7 0.03LVM leftventricularmassingm 1.9yearposttransplant 23 110.5 119.1 8.6 0.37LVMindex leftventricularmassindexingm/m2.7 1.9yearposttransplant 23 43.9 39.3 -4.6 0.19

Thelastechocardiogrambeforetransplantationorthemostrecentechocardiogram(forindividualsnottransplanted)wasanalyzedasrepresentingthemostrelevantdataavailabletothetransplantingphysician

LVEDD leftventricularend-diastolicdiameter(40-56mm) 4.2years 739 ND 52(47,57) NA ND

ALVESD leftventricularend-systolicdiameter(20-38mm) 739 ND 33(29,39) NA NDFS fractionalshortening(23%-45%) 739 ND 35(30,40) NA NDLVejectionfraction >50% 739 ND 60(50,66) NA ND

baselineandannualechocardiographywereperformedusingM-modeandtwo-dimensionalultrasonography.

LVfunction leftatrialdiameterinmm 47months 102 39 37 -2 0.002

ALVEDD LVenddiastolicdiameterinmm 47months 102 52 50 -2 0.004LVESD LVendsystolicdiameterinmm 47months 102 34 31.5 -2.5 0.001IVS ventricularseptalwallthicknessindiastole 47months 102 12.2 11.7 -0.5 0.07LVPW posteriorLVwallthicknessindiastole 47months 102 12.1 11.7 -0.4 0.018FS fractionalshortening 47months 102 35 37 2 0.04LVMindex LVmassindexing/m2 47months 102 152 130 -22 <0.0001LVV LVvolumeinmL/m2 47months 102 84 71 -13 <0.0001

KDIGO-TransplantCandidateGuidelineTopic:EchocardiographyQualityAssessment


PMID Author Year



















nodescription

11472607 Mitsnefes 2001 NA NA NA NA NA low23542473 Stallworthy 2013 NA NA NA NA NA low7491692 Parfrey 1995 NA NA NA NA NA low24009216 Kainz 2013 NA NA NA NA NA low

KDIGO-TransplantCandidateGuidelineTopic:EchocardiographyQualityAssessment

PMID Author Year

11472607 Mitsnefes 200123542473 Stallworthy 20137491692 Parfrey 199524009216 Kainz 2013






yes;no;unclear










extracteddata.



low NA low unclear low nonelow NA low unclear low nonelow NA low unclear low nonelow NA n unclear low none

Evidence Profile Guideline: Pre-transplantation echocardiography

Outcome Predictor # of Studies

Total N of Patients



Directness of the

Evidence, including

Applicability



for Outcome


Outcome

Death* Echo parameters



(0)

Direct (0)

Sparse, per parameter

(-2)

Low Pre-Txp echo parameters predict post-Txp death: lower LVEF and FS, higher LVESD, LVEDD, LAD (e.g., >53 mm)

Critical

Impairment 1 739 No limitations (0)

N/A Indirect† (-1)

Sparse (-2)

Very low

Severe impairment is a significant predictor of post-Txp death

Pulm HTN 1 739 No limitations (0)

N/A Direct (0)

Sparse (-2)

Low Pulm HTN on pre-Txp echo doubles risk of post-Txp death

RWMA 1 739 No limitations (0)

N/A Direct (0)

Sparse (-2)

Low RWMA on pre-Txp echo doubles risk of post-Txp death

Graft loss Echo parameters



(0)

Direct (0)

Sparse (-2)

Low Higher RAD associated with higher risk of graft loss, E/e` >=15 associated with higher risk of graft loss

Critical

LV function Echo 2 125 No limitations (0)


(0)

Indirect‡ (-1)

Small sample (-1)

Low Prevalence of LVH (and subtypes) remains stable pre-Txp vs. 2 & 4 years post-Txp. Syst dysfxn fully resolves by 4 years post-Txp. Prevalence of normal echo doubles by 4 years post-Txp.

High

Overall summary: Pre-transplant echo parameters and findings are associated with post-transplantation death and graft loss.


Studies included in EP: PMID 11472607; PMID 23542473; PMID 7491692; PMID 24009216; PMID 26750652; PMID 27841080 Abbreviations: Echo = echocardiography, E/e`=Early diastolic transmitral flow velocity (E) in combination with early diastolic mitral annular velocity (e`), FS = fractional shortening, LAD = left atrial diameter, LVEDD = left ventricular end diastolic diameter, LVEF = left ventricular ejection fraction, LVESD = left ventricular end systolic diameter, Pulm HTN = pulmonary hypertension, RAD = right atrial diameter, RMWA = regional wall motion abnormalities, Syst dysfxn = systolic dysfunction, Txp = kidney transplant. * Overall similar findings for cardiovascular death from 1 study (N=739); LVEF <55% associated with shorter survival time (P=0.002) from 1 study (N=1763) † Impairment defined variably by sonographers ‡ Only comparisons of prevalence of LV function pre- and post-Txp

KDIGO-TransplantCandidateGuidelineTopic:CarotidscreeningCategoricaloutcomes




%MaleBaselineCKD

stageBaselinekidney

functionInterventiondescription Arm(Intervention)

18045824 Aull-Watschinger,S.andKonstantin,H.andDemetriou,D.andSchillinger,M.andHabicht,A.andHorl,W.H.andWatschinger,B.

2008 peer-reviewed Austria 1995-2005 retrospectivesingle-center >18 66% ESRD nd Carotidduplexultrasound plaques

stenosis25-50%stenosis51-70%stenosis>70%

KDIGO-TransplantCandidateGuidelineTopic:CarotidscreeningCategoricaloutcomes

PMID Author Year


2008


measurementtimepoint



TIA/Stroke 4ypost-Txp(median) 809 4.9%(40) Reference(nostenosis) B

TIA/Stroke 44 18.2%(8) HR:1.68(0.59,4.78)TIA/Stroke 50 4.0%(2) HR:1.54(0.47,2.76)TIA/Stroke 9 11.1%(1) HR:1.71(0.20,15.06)


GuidelineTopic:Carotidscreening

QualityAssessment

RCT:Adequategenerationofarandomizedsequence RCT:.....Allocationconcealment RCT:.....BlindingofPATIENTS RCT:.....BlindingofPROVIDERS RCT.....Intention-to-treat-analysis NonRCT…..Representativenessofthecase? NonRCT…..Selectionoftheexposedcohort NonRCT…..Ascertainmentofexposure

PMID Author Year















































nodescription



nodescription



nodescription


2008 na na na na na notrepresentative drawnfromthesamesource nodescription


GuidelineTopic:Carotidscreening

QualityAssessment

PMID Author Year


2008




accountedfor





yes;no;unclear














bias


















extracteddata.







yes na na unclear thereare10missingpatients(samplesizeis922buttablenumbersaddto912)

low

Evidence Profile Guideline: Carotid artery testing

Intervention Outcome # of Studies

Total N of Patients







Evidence for Outcome

Description of Findings

Importance of Outcome

Carotid duplex ultrasound

TIA or Stroke 1 912 Serious limitation

(-1)

N/A Direct (0)

Imprecise, sparse

(-2)

Very low Pre-transplant carotid stenosis not associated with post-transplant events

Critical

Overall summary: Imprecise evidence that pre-transplantation carotid stenosis is not associated with post-transplantation stroke or TIA


Studies included in EP: PMID 18045824 Abbreviations: N/A = not applicable, TIA = transient ischemic attack

KDIGO-TransplantCandidateGuidelineTopic:ADPKD-relatedcerebralaneurysmCategoricaloutcomes

PMID Author Year Typeofarticle Country Era Studydesign Samplesize(N) Age[mean{SD}ormedian(range)]


Baselinekidneyfunction %Hypertension Arm(Intervention) Interventiondescription

23449651 Niemczyk 2013 peer-reviewedpublicationPoland 2009-2012 prospectivecohortstudy 83ADPKD 46{15} 38.6 1:27.7%,

2:24.1%,

3:30.1%,

4:16.9%,

5:1.2%

ND arterialhypertension:96.4% MRAstudyfor

intracranialaneurysms,

confirmedbyCTA

MRresultswereverifiedbyuseofCT

angiographyandwerethenreferredtoa

specialistinneurosurgery.

11981069 Graf 2002 peer-reviewedpublicationGermany ND prospectivecohortstudy 43ADPKD 45.7(12.9) 48.8 ND normal:37.2%,impaired:

34.9%,ESRD:25.6%

MRAstudyfor

intracranialaneurysms

MRAperformedusing3Dphase-contrast

imaginesequencesand2Dinflowimage

sequence.

Wakabayashi 1983 peer-reviewedpublicationJapan 1981-1982 prospectivecohortstudy 17ADPKD mean42(32-66) 41.2 ND ND 52.9 Angiographyfor

intracranialaneurysm

fourvesselangiography

15086900 Gibbs 2004 peer-reviewedpublicationUS 1989-2002 retrospectivecohortstudy 21(ADPKD,knownunrupturedaneurysm) 47.9(calculated) 33.30% ND ND ND MRangiographic

screening

three-dimensionaltime-of-flightMR

angiography

KDIGO-TransplantCandidateGuidelineTopic:ADPKD-relatedcerebralaneurysmCategoricaloutcomes

PMID Author Year

23449651 Niemczyk 2013

11981069 Graf 2002

Wakabayashi 1983

15086900 Gibbs 2004

Outcome OutcomeMeasurementTimepoint

Definition Subgroup Samplesize(N) Frequency(Event)Rate,%


cerebralaneurysms ND Anyaneurysm All 83 (14)16.9% B

Newlydiagnosed <=45yearsold(posthocthreshold) 34 (1)2.9% ND <0.05Newlydiagnosed >45yearsold 49 (11)22.4%

death ND deathduetosubcranialhemorrhage

ICA 6 (2)33.3% ND ND B

Dolichoectasia 2 0%Normal 35 0%

cerebralaneurysms Familyhxofstroke 32 (3)9.4% ND ND

FamilyhxofICAorintracranialbleed 11 (3)27.2%

cerebralaneurysms ND All 17 (7)41.2% B

Hypertension 9 (2)22.2% ND NDNohypertension 8 (5)62.5%

Aneurysmgrowth 81(13-160)mopost-firsteval Follow-upstudy 18 1(5.6%) B

Newaneurysm 81(13-160)mopost-firsteval Follow-upstudy 18 1(5.6%)

Aneurysmrupture 92(18-187)mopost-firsteval All 21 0%

KDIGO-TransplantCandidateGuidelineTopic:ADPKD-relatedcerebralaneurysmQualityAssessment

RCT:Adequategenerationofarandomizedsequence RCT:.....Allocationconcealment RCT:.....BlindingofPATIENTS RCT:.....BlindingofPROVIDERS RCT.....Intention-to-treat-analysis NonRCT…..Selectionoftreatedandcontrolcohort?NonRCT…..Demonstrationthatoutcomeofinterestwasnot


PMID Author Year




















23449651 Neimczyk 2013 NA NA NA NA NA NA low,althoughaneurysmsweresuspected11981069 Graf 2002 NA NA NA NA NA NA low,althoughaneurysmsweresuspected0 Wakabayashi 1983 NA NA NA NA NA NA NA,nofollow-up(screening)15086900 Gibbs 2004 NA NA NA NA NA n low,althoughaneurysmsweresuspected

KDIGO-TransplantCandidateGuidelineTopic:ADPKD-relatedcerebralaneurysmQualityAssessment

PMID Author Year

23449651 Neimczyk 201311981069 Graf 20020 Wakabayashi 198315086900 Gibbs 2004














extracteddata.



NA NA unclear low noneNA NA unclear low noneNA NA unclear low noneNA NA unclear low none

Evidence Profile Guideline: Intracranial imaging in patients with ADPKD


Total N of Patients







for Outcome


Outcome


(-1)

N/A Direct (0)

Sparse, small (-2)

Very low 2/43 (4.7%) died of subcranial hemorrhage; both among 6 patients found to have aneurysm; no deaths among other 37 patients

Critical

Aneurysm rupture


(-1)

N/A Direct (0)

Sparse, small (-2)

Very low 0% after a mean of 7.7 years since aneurysm found. Critical

Aneurysm 3 143 Serious limitations

(-1)


(0)

Direct (0)

Small studies, intermediate

outcome (-1)

Low Approximately 20-40% ADPKD patients found to have aneurysms. One study found only 1 small newly diagnosed aneurysm among 34 patients ≤45 years old compared to 22% of 49 older patients. One study each found higher prevalence in patients with family history of ICA or bleed than those with family history of stroke, and in patients without hypertension than with (both NS).

High

Change in aneurysm


(-1)

N/A Direct (0)

Sparse, small (-2)

Very low Among 18 ADPKD patients found to have aneurysm, only 1 each had aneurysm growth or new aneurysms over a mean of 7 years

High

Overall summary: Evidence does not directly address whether ADPKD patients benefit from intracranial testing for aneurysms. Data on death from intracranial bleeding and on rate of aneurysm rupture are inconsistent. Possibly patients ≤45 years

old are very unlikely to have aneurysm. Some evidence that aneurysms rarely change over time,


Studies included in EP: PMID 23449651; PMID 11981069; PMID 6827344; PMID 15086900

KDIGO-TransplantCandidateGuidelineTopic:ThrombophiliaCategoricaloutcomes





Testing/Subgroup Intervention Outcome

10798752 Vaidya 2000 peer-reviewedjournalarticle USA 1995-1998 unclear nd 55% CKD5 HD APASscreening ACAelevatedAPASdiagnosis

APAS&KTx Pre-Txpanticoagulation Graftloss,1yearPeri-Txpanticoagulation Graftloss,1yearNoanticoagulation Graftloss<1week

HighACA(notAPAS)&KTx GraftlossNormalACA,noAPAS&KTx Graftloss

15476477 Forman 2004 perr-reviewedjournalarticle USA 1996-2001 retrospective [44.9{2.1}] 61% CKD5 HD ACAScreening ACAelevatedACApositive delayedgraftfunctionACAnegativeACAposvs.neg graftloss

APAS Peri-Txpanticoagulation Graftloss,1monthNoanticoagulation

22507396 Vaidya 2012 peer-reviewedjournalarticle USA 1992-2009 unclear nd 52% CKD5 HD APASScreening APASdiagnosis

APAS&KTx LMWHpost-Txp Graftloss,1yearNoanticoagulation

ACAScreening ACAIgGorIgMorbothACA&KTx Graftloss,10year

11502996 Wuthrich 2001 peer-reviewedjournalarticle Switzerland 1996-1999 unclear nd nd CKD5 HD FactorVLeiden FVLmutationFVLmutation&KTx graftloss

19845577 Ghisdal 2010 peer-reviewedjournalarticle Belgium 2001-2006 prospective [47.8{0.2}] 66.5% CKD5 HD Testingondayoftransplant AntithrombinProteinCdeficiencyProteinSdeficiencyAPCresistanceFactorVIIIcFactorIXLupusanticoagulantAntiphospholipidantibodiesPT(G20210A)variantGPIIIa(T1565C)variantFV(G1691A)variant

>=1thrombophilicfactor Graftsurvival,4yearsNothrombophilicfactors>=1thrombophilicfactor Patientsurvival,4yearsNothrombophilicfactors

17032424 Kranz 2006 peer-reviewedjournalarticle Germany 1998-2003 prospective [10.1{1.5}] 33% CKD4-5 PD/HD Thrombophiliatesting ThrombophilicriskfactorsC667TmutationoftheMTHFRgene





Testing/Subgroup Intervention Outcome

factorVLeidenmutation(FV506Q)antiphospholipidantibodies(anticardiolipinantibodies,lupusanticoagulant)prothrombinmutation(G20210A)proteinCdeficiency

>=1thrombophilicfactor Graftloss,3.3yNothrombophilicfactors

KDIGO-TransplantCandidateGuidelineTopic:ThrombophiliaCategoricaloutcomes

PMID Author Year

10798752 Vaidya 2000

15476477 Forman 2004

22507396 Vaidya 2012

11502996 Wuthrich 2001

19845577 Ghisdal 2010

17032424 Kranz 2006

Definition Samplesize(N) Frequency(event)rate,% Relativeeffect Pvalue Overallquality

IgG>10units,IgM>15units,IgA>7units 502 19%(93) Bdocumentedlupus,frequentabortions,AVshuntthrombosis,thrombocytopenia,cerebrovascularthrombosis,microrenalangiopathy

502 4.6%(23)

2 0% nd nd2 50%(1atday5)7 100%(7)37 27%(10),noneduetothrombosis207 86%,noneduetothrombosis337 18%(61) B60 10%(60) 0.53274 14%(38)337 1.65(0.69,3.97),adjusted

forpost-Txpcoumadin8 0%1 100%(1),atday4

patientswererequiredtohaveahistoryofclottingdisordersofoneormoreofthefollowing:(i)biopsy-establishedmicro-renalangiopathy,(ii)morethansixA-Vshuntthromboses,(iii)ahistoryoflupus,(iv)frequentspontaneousabortions,and(v)thrombocytopenia.

1625 2.4%(39) C

10 20%(2)11 27%(3)

presenceofACA 1625 5.8%(94)46 72% NSvs.cadaveric(ACA/APASneg,

P=0.051);"Lower"vs.livingdonor(ACA/APASneg,P=0.0036)

202 4.0%(8) B8 25%(2)

309 14.2% B301 13.0%302 5.3%310 2.6%309 20.4%214 1.4%304 38.2%286 26.9%291 2.4%289 29.8%291 2.4%250 81.2% NS60 83.7%250 91.7% NS60 95.9%66children 27.3% B66children 10.6%

PMID Author Year Definition Samplesize(N) Frequency(event)rate,% Relativeeffect Pvalue Overallquality

66children 7.6%66children 4.5%

66children 1.5%66children 1.5%18children 5.6%(1,fromdenovoGN) NS48children 4.2%(2,fromchronicrejection,recurrenceofoxalosis)

KDIGO-TransplantCandidateGuidelineTopic:ThrombophiliaQualityAssessment


PMID Author Year





















11502996 Wuthrich 2001 N/A N/A N/A N/A N/A trulyrepresentative drawnfromthesamesource

19845577 Ghisdal 2010 N/A N/A N/A N/A N/A trulyrepresentative drawnfromthesamesource

15476477 Forman 2004 N/A N/A N/A N/A N/A trulyrepresentative drawnfromthesamesource

22507396 Vaidya 2012 N/A N/A N/A N/A N/A nodescription drawnfromthesamesource

KDIGO-TransplantCandidateGuidelineTopic:ThrombophiliaQualityAssessment

PMID Author Year

11502996 Wuthrich 2001

19845577 Ghisdal 2010

15476477 Forman 2004

22507396 Vaidya 2012

















extracteddata.







Evidence Profile Guideline: Thrombophilia testing


Total N of Patients



Directness of the

Evidence, including

Applicability



for Outcome


Outcome

Death, ≥1 thrombophilia factor


(-1)

N/A Direct (0)

Sparse (-1)

Low Thrombophilia factors not a predictor of post-transplant death

Critical

Graft loss, Antiphospholipid Ab syndrome


(-1)


(0)

Direct (0)

Moderate Pre-transplant anticoagulation mostly prevents acute graft loss

Critical

Anticardiolipin Ab + 3 420 Serious limitations

(-1)


(0)

Direct (0)

Moderate Not a significant predictor of graft loss

Factor V Leiden mutation 1 8 Serious limitations

(-1)

N/A Direct (0)

Sparse, small sample

(-2)

Very low 25% graft loss

≥1 thrombophilia factor 2 376 (66 children)

Serious limitations

(-1)


(0)

Direct (0)

Moderate Not a significant predictor of graft loss

Prevalence, Anticardiolipin Ab


(-1)


(-1)

Direct (0)

Low 6-19%

Antiphospholipid Ab adults


(-1)

N/A Direct (0)

Sparse (-1)

Low 27%

children 1 66 Serious limitations

(-1)

N/A Direct (0)


(-1)

Very low 4.5%

Antiphospholipid Ab syndrome 2 2127 Serious limitations

(-1)


(0)

Direct (0)

Moderate 2.4-4.6%

Antithrombin 1 309 Serious limitations

(-1)

N/A Direct (0)

Sparse (-1)

Low 14%

Activated protein C resistance 1 310 Serious limitations

(-1)

N/A Direct (0)

Sparse (-1)

Low 2.6%

Factor IX 1 214 Serious limitations

(-1)

N/A Direct (0)

Spars (-1)

Low 1.4%

FVL variant (FV506Q) children


(-1)

N/A Direct (0)


(-1)

Very low 7.6%

FVL variant (G1691A) 1 291 Serious limitations

(-1)

N/A Direct (0)

Sparse (-1)

Low 2.4%

Factor VIIIc 1 309 Serious limitations

(-1)

N/A Direct (0)

Sparse (-1)

Low 20%

Glycoprotein IIIa variant (T1565C)


(-1)

N/A Direct (0)

Sparse (-1)

Low 30%

Lupus anticoagulant 1 308 Serious limitations

(-1)

N/A Direct (0)

Sparse (-1)

Low 38%

MTHFR variant (C667T), children


(-1)

N/A Direct (0)


(-1)

Very low 11%

Protein C deficiency, adults


(-1)

N/A Direct (0)

Sparse (-1)

Low 13%

children 1 66 Serious limitations

(-1)

N/A Direct (0)


(-1)

Very low 1.5%

Protein S deficiency 1 302 Serious limitations

(-1)

N/A Direct (0)

Sparse (-1)

Low 5.3%

Prothrombin variant (G20210A) 2 357 (66 children)

Serious limitations

(-1)


(0)

Direct (0)

Sparse (-1)

Moderate 1.5-2.4%

Overall summary: Antithrombotic factors are not predictors of post-transplantation death or graft loss. Except that patients with antiphospholipid Ab

syndrome who do not receive pre-transplantation anti-coagulation are at high risk of graft loss.

Quality of Overall Evidence: Low to moderate

Studies included in EP: PMID 10798752; PMID 15476477; PMID 22507396; PMID 11502996; PMID 19845577; PMID 17032424. Abbreviations: Ab = antibody, FVL = factor V Leiden, MTHFR = methylenetetrahydrofolate reductase, N/A = not applicable.

Documents

KDIGO CLINICAL PRACTICE GUIDELINE ON THE EVALUATION … · 14508 All Txp First KTxp, on HD or PD before Txp nd nd 48 (14) 61 nd 27 nd nd nd nd nd nd nd nd 27 reported as comorbidity