Effective treatment of kidney transplantation: A Synthesis of Findings from 15 Studies

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Original Abstract of the Article

Key Research Findings

Kidney transplantation is the most effective treatment for patients with end-stage renal disease (ESRD). 3 It is associated with lower mortality and improved quality of life compared to dialysis. 4 However, kidney transplantation requires the use of immunosuppressive drugs to prevent rejection. 3 These drugs can have side effects, such as kidney damage and cardiovascular problems. 1 The optimal treatment for post-kidney transplant recipients is still under debate. 11

Live donor kidney transplantation is a common procedure, but it can cause subclinical acute kidney injury in donors. 8 Preoperative intravenous fluids may help to reduce this risk. 8

The increasing age of donors can lead to the diagnosis of a higher number of small renal masses (SRMs) which are most frequently renal cell carcinomas (RCCs). 9 A number of studies have reported their experience using kidneys with SRMs for transplantation. 9

Kidney transplantation is associated with longer survival and improved quality of life compared to dialysis. 15 However, patients with kidney failure often present with reduced cardiovascular reserve. 15

Treatment Summary

Standard protocols for kidney transplantation typically involve three drug groups, each directed to a site in the T-cell activation or proliferation cascade. 3 The three groups are: calcineurin inhibitors (e.g. cyclosporine, tacrolimus), anti-proliferative agents (e.g. azathioprine, mycophenolate mofetil), and steroids (prednisolone). 3 It remains unclear whether new regimens are more specific or simply more potent immunosuppressants. 3

Tacrolimus and cyclosporin are commonly used calcineurin inhibitors for kidney transplant recipients. 3 Azathioprine and mycophenolate mofetil are frequently used anti-proliferative agents in combination with calcineurin inhibitors. 3

Bisphosphonate and its supplements are used to treat bone loss in kidney transplant recipients. 11

Plasmapheresis is a treatment for antibody-mediated rejection in kidney transplant recipients. 10

Machine perfusion preservation and static cold storage are both methods for preserving kidneys for transplantation. 12

Benefits and Risks

Benefit Summary

Kidney transplantation is the optimal treatment for end-stage renal disease (ESRD) with longer survival and improved quality of life compared to dialysis. 4 Kidney transplantation is also associated with a reduced risk of cardiovascular events. 4

Risk Summary

Kidney transplantation can be associated with risks including rejection, surgical complications, and bone loss. 2 11 Long-term immunosuppressive therapy can also lead to side effects such as kidney damage and increased cardiovascular risk factors. 1

Comparison between Studies

Similarities

Many studies indicate that kidney transplantation is associated with lower mortality and improved quality of life compared to dialysis. 4 Many studies also indicate that immunosuppressive therapy can reduce rejection but has side effects such as kidney damage and cardiovascular problems. 3 1

Differences

Some studies compare the effectiveness and side effects of different immunosuppressive therapies. 3 7 Studies may also differ in their surgical methods and post-transplant management protocols.

Consistency and Contradictions

Many studies show that kidney transplantation improves survival and quality of life compared to dialysis. 4 However, results may vary depending on the type and dosage of immunosuppressive therapy used and the quality of the transplanted kidney. 3

Real-life Application

Kidney transplantation is an effective treatment for ESRD but faces challenges such as donor shortage. 14 Kidney transplantation is also an expensive procedure, creating a significant financial burden. 5

Limitations of Current Research

Kidney transplantation research faces various limitations, such as the difficulty of establishing causality in observational studies. 4 Furthermore, differences in patient backgrounds, treatment methods, and research protocols can make comparing results challenging.

Future Research Directions

Future research on kidney transplantation should focus on optimizing immunosuppressive therapies, addressing the donor shortage, and mitigating the financial burden associated with the procedure. 7 14 5

Conclusion

Kidney transplantation is an effective treatment for ESRD but involves risks such as rejection and surgical complications. 2 The decision to undergo transplantation should be made in consultation with a physician, considering individual patient health and risk factors. Appropriate care and management are crucial for those undergoing kidney transplantation. Efforts to increase donor availability and provide financial support are essential to promote wider adoption of kidney transplantation.

Treatment Keywords

calcineurin inhibitors, anti-proliferative agents, steroids, tacrolimus, cyclosporin, azathioprine, mycophenolate mofetil, prednisolone, bisphosphonate, plasmapheresis, machine perfusion preservation, static cold storage 3 8 11 10 12

Literature analysis of 15 papers
Positive Content
15
Neutral Content
0
Negative Content
0
Article Type
3
5
12
4
15
1.

Randomized study on the conversion of treatment with cyclosporine to azathioprine or mycophenolate mofetil followed by dose reduction.

Author: Smak GregoorP J, van GelderT, van BesouwN M, van der MastB J, IJzermansJ N, WeimarW

Improved graft survival
Reduced CsA-related adverse effects

This study examined the long-term use of cyclosporine (CsA) in kidney transplantation and the benefits of switching patients to azathioprine (AZA) or mycophenolate mofetil (MMF) after one year to avoid CsA-related adverse effects.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

2.

Spectrum of surgical complications after simultaneous pancreas-kidney transplantation in a prospectively randomized study of two immunosuppressive protocols.

Author: SteurerWolfgang, MalaiseJacques, MarkWalter, KoenigsrainerAlfred, MargreiterRaimund,

SPK transplantation
Surgical complications

This report analyzes the surgical complications experienced by patients receiving tacrolimus and cyclosporin microemulsion (ME)-based therapy for simultaneous pancreas-kidney transplantation (SPK).

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

3.

Tacrolimus versus cyclosporin as primary immunosuppression for kidney transplant recipients.

Author: WebsterA, WoodroffeR C, TaylorR S, ChapmanJ R, CraigJ C

Improved kidney transplant treatment
Reduced rejection
End-stage renal disease

Kidney transplantation is the best treatment for most people with end-stage kidney disease. Standard treatment involves a combination of medications, each targeting a different part of the immune system to prevent rejection. While newer regimens are used, it's unclear if they are more specific or simply stronger at suppressing the immune system.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

4.

Systematic review: kidney transplantation compared with dialysis in clinically relevant outcomes.

Author: TonelliM, WiebeN, KnollG, BelloA, BrowneS, JadhavD, KlarenbachS, GillJ

Improved cardiovascular outcomes
Improved quality of life
Reduced mortality

This systematic review summarizes the benefits of kidney transplantation compared to chronic dialysis treatment for adults, examining factors associated with greater or lesser benefit.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

5.

Cost-effectiveness analysis of the early conversion of tacrolimus to mammalian target of rapamycin inhibitors in patients with renal transplantation.

Author: GamboaO, MonteroC, MesaL, BenavidesC, ReinoA, TorresR E, CastilloJ S

Treatment of renal failure

Kidney transplantation and dialysis are the only treatments for people with end-stage kidney failure. These treatments have transformed this once fatal condition into a manageable chronic illness. Kidney transplant patients require medications to suppress the immune system and prevent rejection. Several medications are available, each with varying effectiveness, safety, and costs.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

6.

Influence of renal function on long-term graft survival and patient survival in renal transplant recipients.

Author: Smith-PalmerJ, KalsekarA, ValentineW

Improved graft survival
Improved patient survival

This review examines the relationship between post-transplantation renal function and long-term graft survival and patient survival in kidney transplant recipients.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

7.

Mycophenolic acid versus azathioprine as primary immunosuppression for kidney transplant recipients.

Author: WagnerMartin, EarleyAmy K, WebsterAngela C, SchmidChristopher H, BalkEthan M, UhligKatrin

MPA for kidney transplantation
High cost

This research examines the comparative effects of azathioprine (AZA) and mycophenolic acid (MPA) for immunosuppression after kidney transplantation. MPA is often favored over AZA, but the study explores the trade-offs between effectiveness, cost, and other factors.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

8.

A comparison of the effects of oral vs. intravenous hydration on subclinical acute kidney injury in living kidney donors: a protocol of a randomised controlled trial.

Author: MackinnonShona, AitkenEmma, GhitaRyan, ClancyMarc

Improved donor renal function
Improved recipient graft longevity

This research discusses the use of preoperative intravenous fluids to minimize the risk of acute kidney injury in living kidney donors undergoing laparoscopic donor nephrectomy. The study explores the potential benefits of hydration for preserving donor renal function.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

9.

Effectiveness and Harms of Using Kidneys with Small Renal Tumors from Deceased or Living Donors as a Source of Renal Transplantation: A Systematic Review.

Author: HeviaVital, Hassan ZakriRhana, Fraser TaylorClaire, BruinsHarman Maxim, BoissierRomain, LledoEnrique, RegeleHeinz, BuddeKlemens, FigueiredoArnaldo, BredaAlberto, YuanCathy Yuhong, OlsburghJonathon

Increased kidney transplant pool
Renal cell carcinoma

This abstract discusses the increasing number of small renal masses (SRMs) in older kidney donors and explores the feasibility of using kidneys with SRMs for transplantation to increase the pool of available organs.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

10.

Plasmapheresis Therapy in Kidney Transplant Rejection.

Author: XiePan, TaoMin, PengKanfu, ZhaoHongwen, ZhangKeqin, ShengYuxiu, AnkawiGhada, RoncoClaudio

KT treatment
Therapeutic plasma exchange

Kidney transplantation is the best treatment for kidney failure. However, some people have antibodies that make finding a suitable donor kidney difficult. Plasma exchange is a treatment that can effectively reduce antibodies. While plasma exchange is helpful, individualised treatment plans and combining therapies are important to achieve the best outcomes. Early diagnosis and treatment can reduce complications and costs.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

11.

Outcomes of bisphosphonate and its supplements for bone loss in kidney transplant recipients: a systematic review and network meta-analysis.

Author: YangYan, QiuShi, DengLinghui, TangXi, LiXinrui, WeiQiang, FuPing

Bone disease treatment

This study evaluates the efficacy and safety of bisphosphonate and its combined therapies in treating mineral bone disease, a common complication after kidney transplantation.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

12.

Machine perfusion preservation versus static cold storage for deceased donor kidney transplantation.

Author: TingleSamuel J, FigueiredoRodrigo S, MoirJohn Ag, GoodfellowMichael, TalbotDavid, WilsonColin H

Kidney perfusion
Kidney transplantation

Kidney transplantation is the best treatment for kidney failure, but the process of removing, transporting, and transplanting the kidney can damage it. Currently, kidneys are stored on ice during transport, but new technology allows for "pumping" the kidney with fluids at different temperatures. This study explores the effectiveness of these new techniques, focusing on how they impact delayed graft function (DGF), a condition where the transplanted kidney doesn't start working right away.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

13.

Employment of patients with kidney failure treated with dialysis or kidney transplantation-a systematic review and meta-analysis.

Author: KirkeskovLilli, CarlsenRasmus K, LundThomas, BuusNiels Henrik

Kidney failure employment

Patients with kidney failure who are on dialysis or have undergone kidney transplantation often experience difficulty maintaining employment.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

14.

[Renal harvest. State of the art.]

Author: ColomaLidia, CabelloRamiro, BuenoGonzalo, QuiciosCristina, García-CardosoJuan Vicente, González-EnguitaCarmen

Improved graft survival
Increased organ supply

Kidney transplantation is the optimal treatment for end-stage renal disease, but organ availability often lags behind demand. This paper reviews current strategies to increase the pool of transplantable organs, including optimizing donor management and preservation methods, to address this gap.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : Spanish

15.

Effect of kidney transplantation on indices of cardiorespiratory fitness assessed with cardiopulmonary exercise testing: a systematic review and meta-analysis.

Author: PellaEva, AlexandrouMaria-Eleni, BoutouAfroditi, TheodorakopoulouMarieta, DiplaKonstantina, ZafeiridisAndreas, SarafidisPantelis

Improved cardiovascular fitness

Kidney transplantation (KT) is associated with improved cardiorespiratory fitness, including increased oxygen consumption at anaerobic threshold.

Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

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