Priority 7 from the Kidney Transplant PSP

UNCERTAINTY: How can we encourage tolerance to the transplant to prevent or reduce the need for immunosuppression (e.g. by use of T-regulatory cells, induction of haemoxygenase 1)?
Overall ranking	Priority questions agreed on but not put in ranked order
JLA question ID	0037/7
Explanatory note	Not available for this PSP
Evidence	Ongoing Randomised Controlled Trials: Reinders, M., Bank, J. R., Dreyer, G. J., Roelofs, H., Heidt, S., Roelen, D. L., Huurman, V., Lindeman, J., van Kooten, C., Claas, F., et al. Autologous bone marrow derived mesenchymal stromal cell therapy in combination with everolimus to preserve renal structure and function in renal transplant recipients. Journal of Translational Medicine. 2014;12(1):331 ~ Belatacept Post Depletional Repopulation to Facilitate Tolerance. NCT00565773~ Libetta, C, Canevari, M, Margiotta, E, Martinelli, C, Borettaz, I, Esposito, P, Sepe, V, Rampino, T, Dal Canton, A Preliminary data of controlled randomized study (ever twist) on tolerance induction 16th Congress of the European Society for Organ Transplantation. Vienna, Austria. September 8-11, 2013. 2013
Health Research Classification System category	Renal and Urogenital

Extra information provided by this PSP
Original uncertainty examples	Will I have to take the medication for ever? For how long do I need to take immunosupression medication? Immuno-suppressants, whilst life-savers during the transplantation process, are also toxic. Can we speed up research to find an alternative or reduce their usage post-operatively? How can we induce tolerance in kidney transplant recipients? Will transplants in the future not require anti-rejection drugs Can we prevent transplant rejection without using drugs? What are the factors that prevent transplant rejection in some individuals (tolerance)? Are there any on going study on tolerance in Kidney transplantation? What in vivo evidence is there that medications that do not interfere with the generation of regulatory T cells are beneficial in clinical renal transplantation? Is now the time to begin planning a UK follow-up to the ONE Study? Does the induction of haemoxygenase I in deceased donor transplant recipients improve outcomes?
Comparison	Drug
Submitted by	Patients x 3 Clinicians x 9
Outcomes to be measured	Patient and graft survival, graft function, adverse events

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