Quality metrics in solid organ transplantation: protocol for a systematic scoping review.

Background: Transplantation is often the best, if not the only treatment for end-stage organ failure; however, the quality metrics for determining whether a transplant program is delivering safe, high quality care remains unknown. The purpose of this study is to identify and describe quality indicators or metrics in patients who have received a solid organ transplant.

Methods/design: We will conduct a systematic scoping review to evaluate and describe quality indicators or metrics in patients who have received a solid organ transplant.

Effect of sirolimus on malignancy and survival after kidney transplantation: systematic review and meta-analysis of individual patient data.

Objective: To examine risk of malignancy and death in patients with kidney transplant who receive the immunosuppressive drug sirolimus.

Design: Systematic review and meta-analysis of individual patient data.

Data Sources: Medline, Embase, and the Cochrane Central Register of Controlled Trials from inception to March 2013.

The therapeutic potential of C-peptide in kidney disease: a protocol for a systematic review and meta-analysis.

Background: Kidney disease remains a major cause of morbidity and mortality in Canada and worldwide. New medical treatments are needed to reduce the progression of kidney disease to improve patient outcomes. C-peptide is normally released by pancreatic beta-cells along with insulin in healthy individuals, and has been shown to have intrinsic biological activity and to potentially be renoprotective.

Kidney transplantation in the older adult.

The end-stage renal disease population is aging. Nearly half of all new patients are older than 65 years and one third are older than 70 years. Assessing the possibility of transplantation for older patients with end-stage renal disease often involves contemplating more complex issues, including cognitive impairment, decreased functional status, and frailty, which makes selecting appropriate candidates more difficult.

Is kidney transplantation for everyone? The example of the older dialysis patient.

For the average patient with ESRD, kidney transplantation improves quality of life and prolongs survival compared with patients who are on the transplant waiting list and remain on dialysis. Despite the proven benefits, some patient populations, such as those of older age, may not be referred and accepted for kidney transplantation to the same extent as younger patients. The population with ESRD is aging.

Proteinuria in kidney transplant recipients: prevalence, prognosis, and evidence-based management.

Proteinuria is highly prevalent after kidney transplant, occurring in up to 45% of patients, depending on the definition. In addition to glomerulonephritis, proteinuria in kidney transplant recipients is associated commonly with such transplant-specific diagnoses on biopsy as allograft nephropathy, transplant glomerulopathy, and acute rejection. Proteinuria is associated with decreased patient and allograft survival, as well as an increased risk of cardiovascular events.

Predicting the ideal serum creatinine level following kidney transplantation.

This Practice Point commentary reviews a study by Sberro et al. that evaluated formulae to predict the lowest measured serum creatinine concentration in kidney transplant recipients following surgery. The objective of the study was to ascertain a simple means of identifying patients with inappropriately high serum creatinine concentrations, who are in need of further investigation.

Trends in kidney transplantation over the past decade.

Kidney transplantation offers patients with end-stage renal disease the greatest potential for increased longevity and enhanced quality of life; however, the demand for kidneys far exceeds the available supply. This has led to an increase in the number of people on waiting lists and an increase in waiting time. In the US, the overall median wait time was 2.

The Canadian ACE-inhibitor trial to improve renal outcomes and patient survival in kidney transplantation--study design.

Background: In non-transplant patients with chronic kidney disease and proteinuria, inhibition of the renin-angiotensin system with an ACE-inhibitor or an angiotensin receptor blocker has been shown to delay the progression of renal disease. Observational studies in the kidney transplant population have produced conflicting results with some studies showing benefit and others no benefit of renin-angiotensin system blockade.

Methods: This report describes the design and methodological issues of a randomized controlled trial evaluating the effect of ramipril in a renal transplant population.

A randomized, controlled trial of albumin versus saline for the treatment of intradialytic hypotension.

Intradialytic hypotension (IDH) is the most common complication of hemodialysis. Symptomatic IDH requires the administration of fluid and often results in the early termination of dialysis, both of which may prevent adequate fluid removal. The optimal fluid for the treatment of IDH remains unknown.

Mycophenolate mofetil dose reduction and the risk of acute rejection after renal transplantation.

Mycophenolate mofetil (MMF) significantly decreases acute rejection rates after renal transplantation, but intolerance often occurs, leading to dose reduction. The clinical effect of MMF dose reduction has not been clearly established. This study determined whether MMF dose reduction after renal transplantation was associated with subsequent risk of acute rejection.

Dialysis, kidney transplantation, or pancreas transplantation for patients with diabetes mellitus and renal failure: a decision analysis of treatment options.

Patients with type 1 diabetes mellitus and end-stage renal disease may remain on dialysis or undergo cadaveric kidney transplantation, living kidney transplantation, sequential pancreas after living kidney transplantation, or simultaneous pancreas-kidney transplantation. It is unclear which of these options is most effective. The objective of this study was to determine the optimal treatment strategy for type 1 diabetic patients with renal failure using a decision analytic Markov model.