Priority 5 from the Kidney Transplant PSP

UNCERTAINTY: How can we improve transplant rates in highly sensitised patients?
Overall ranking	Priority questions agreed on but not put in ranked order
JLA question ID	0037/5
Explanatory note	Not available for this PSP
Evidence	Existing Randomised Controlled Trials: Vo, A. A., Choi, J., Cisneros, K., Reinsmoen, N., Haas, M., Ge, S., Toyoda, M., Kahwaji, J., Peng, A., Villicana, R., et al. Benefits of Rituximab Combined With Intravenous Immunoglobulin for Desensitization in Kidney Transplant Recipients. Transplantation. 2014;98(3):312-319 ~ Ghorbani, A, Shahbazian, H, Ehsanpour, A, Aref, A. Alteration of panel-reactive antibodies following treatment with either atorvastatin or low-dose mycophenolate mofetil in sensitized hemodialysis patients. Iranian Journal of Kidney Diseases. 2011;5(5):342-6 ~ Jordan, S. C., Tyan, D., Stablein, D., McIntosh, M., Rose, S., Vo, A., Toyoda, M., Davis, C., Shapiro, R., Adey, D., et al. Evaluation of intravenous immunoglobulin as an agent to lower allosensitization and improve transplantation in highly sensitized adult patients with end-stage renal disease: report of the NIH IG02 trial. Journal of the American Society of Nephrology. 2004;15(12):3256-62 Ongoing Randomised Controlled Trials: Desensitization Protocol for Highly Sensitized Patients on the Waiting List for Kidney Transplant. NCT01502267 ~ An Evaluation of IV Gamma Globulin As a Method to Improve Kidney Transplant Survival in Patients With End-Stage Renal Disease Who Are Highly Sensitized to Transplant Antigens. NCT00000935
Health Research Classification System category	Renal and Urogenital

Extra information provided by this PSP
Original uncertainty examples	How can we safely transplant highly sensitised patients? Can we improve the lot of patients with high panel reactivity? What is the optimal management of the highly sensitised kidney transplant recipient?
Comparison	Surgery
Submitted by	Clinicians x 3
Outcomes to be measured	Transplant rate

PSP information
PSP unique ID	0037
PSP name	Kidney Transplant
Total number of uncertainties identified by this PSP.	90 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	3 February 2016