Mr John O’Callaghan, Centre for Evidence in Transplantation, The Royal College of Surgeons of England.
Methodological Appraisers:
Anam Ayaz-Shah, Centre for Evidence in Transplantation, The Royal College of Surgeons of England
Katriona O'Donoghue, Centre for Evidence in Transplantation, The Royal College of Surgeons of England
Overall Guideline Assessment:
★★★★☆☆☆ (4 of 7)
Appraiser 1
Appraiser 2
Appraiser 3
2
6
5
Recommendation for future use
Appraiser 1
Appraiser 2
Appraiser 3
Yes with modifications
Yes with modifications
Yes with modifications
Domain 1 - Scope and Purpose
94%
Appraiser 1
Appraiser 2
Appraiser 3
1.
The overall objective(s) of the guideline is (are) specifically described
6
7
6
2.
The health question(s) covered by the guideline is (are) specifically described
7
7
7
3.
The population (patients, public, etc.) to whom the guideline is meant to apply is specifically described
6
7
7
Domain 2 - Stakeholder Involvement
28%
Appraiser 1
Appraiser 2
Appraiser 3
4.
The guideline development group includes individuals from all the relevant professional groups
4
4
3
5.
The views and preferences of the target population (patients, public, etc.) have been sought
1
1
1
6.
The target users of the guideline are clearly defined
4
4
2
Domain 3 - Rigour of Development
32%
Appraiser 1
Appraiser 2
Appraiser 3
7.
Systematic methods were used to search for evidence
2
1
2
8.
The criteria for selecting the evidence are clearly described
1
3
3
9.
The strengths and limitations of the body of evidence are clearly described
1
3
4
10.
The methods for formulating the recommendations are clearly described
2
3
3
11.
The health benefits, side effects, and risks have been considered in formulating the recommendations
5
5
6
12.
There is an explicit link between the recommendations and the supporting evidence
6
7
6
13.
The guideline has been externally reviewed by experts prior to its publication
1
1
2
14.
A procedure for updating the guideline is provided
1
1
1
Domain 4 - Clarity of Presentation
78%
Appraiser 1
Appraiser 2
Appraiser 3
15.
The recommendations are specific and unambiguous
5
6
5
16.
The different options for management of the condition or health issue are clearly presented
5
6
6
17.
Key recommendations are easily identifiable
5
6
7
Domain 5 - Applicability
25%
Appraiser 1
Appraiser 2
Appraiser 3
18.
The guideline describes facilitators and barriers to its application
1
5
3
19.
The guideline provides advice and/or tools on how the recommendations can be put into practice
1
6
2
20.
The potential resource implications of applying the recommendations have been considered
1
5
1
21.
The guideline presents monitoring and/ or auditing
3
1
1
Domain 6 - Editorial Independence
33%
Appraiser 1
Appraiser 2
Appraiser 3
22.
The views of the funding body have not influenced the content of the guideline
1
1
1
23.
Competing interests of guideline development group members have been recorded and addressed
6
5
4
Atypical hemolytic uremic syndrome (aHUS) emerged during the last decade as a disease largely of complement dysregulation. This advance facilitated the development of novel, rational treatment options targeting terminal complement activation, e.g., using an anti-C5 antibody (eculizumab). We review treatment and patient management issues related to this therapeutic approach. We present consensus clinical practice recommendations generated by HUS International, an international expert group of clinicians and basic scientists with a focused interest in HUS. We aim to address the following questions of high relevance to daily clinical practice: Which complement investigations should be done and when? What is the importance of anti-factor H antibody detection? Who should be treated with eculizumab? Is plasma exchange therapy still needed? When should eculizumab therapy be initiated? How and when should complement blockade be monitored? Can the approved treatment schedule be modified? What approach should be taken to kidney and/or combined liver-kidney transplantation? How should we limit the risk of meningococcal infection under complement blockade therapy? A pressing question today regards the treatment duration. We discuss the need for prospective studies to establish evidence-based criteria for the continuation or cessation of anticomplement therapy in patients with and without identified complement mutations.
Dr Annemarie Weissenbacher, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
Methodological Appraisers:
Rhiannon Deierhoi Reed, University of Alabama at Birmingham, Comprehensive Transplant Institute, USA
Katriona O'Donoghue, Centre for Evidence in Transplantation, The Royal College of Surgeons of England
Overall Guideline Assessment:
★★★★☆☆☆ (4 of 7)
Appraiser 1
Appraiser 2
Appraiser 3
4
3
6
Recommendation for future use
Appraiser 1
Appraiser 2
Appraiser 3
Yes with modifications
No
Yes
Domain 1 - Scope and Purpose
76%
Appraiser 1
Appraiser 2
Appraiser 3
1.
The overall objective(s) of the guideline is (are) specifically described
6
5
7
2.
The health question(s) covered by the guideline is (are) specifically described
5
5
6
3.
The population (patients, public, etc.) to whom the guideline is meant to apply is specifically described
5
4
7
Domain 2 - Stakeholder Involvement
39%
Appraiser 1
Appraiser 2
Appraiser 3
4.
The guideline development group includes individuals from all the relevant professional groups
5
1
6
5.
The views and preferences of the target population (patients, public, etc.) have been sought
1
1
1
6.
The target users of the guideline are clearly defined
2
7
6
Domain 3 - Rigour of Development
56%
Appraiser 1
Appraiser 2
Appraiser 3
7.
Systematic methods were used to search for evidence
5
7
7
8.
The criteria for selecting the evidence are clearly described
2
4
3
9.
The strengths and limitations of the body of evidence are clearly described
6
7
7
10.
The methods for formulating the recommendations are clearly described
5
1
5
11.
The health benefits, side effects, and risks have been considered in formulating the recommendations
6
4
7
12.
There is an explicit link between the recommendations and the supporting evidence
6
6
7
13.
The guideline has been externally reviewed by experts prior to its publication
1
1
4
14.
A procedure for updating the guideline is provided
1
1
2
Domain 4 - Clarity of Presentation
80%
Appraiser 1
Appraiser 2
Appraiser 3
15.
The recommendations are specific and unambiguous
6
6
6
16.
The different options for management of the condition or health issue are clearly presented
5
7
7
17.
Key recommendations are easily identifiable
6
2
7
Domain 5 - Applicability
33%
Appraiser 1
Appraiser 2
Appraiser 3
18.
The guideline describes facilitators and barriers to its application
2
4
2
19.
The guideline provides advice and/or tools on how the recommendations can be put into practice
1
4
5
20.
The potential resource implications of applying the recommendations have been considered
4
4
1
21.
The guideline presents monitoring and/ or auditing
5
1
3
Domain 6 - Editorial Independence
28%
Appraiser 1
Appraiser 2
Appraiser 3
22.
The views of the funding body have not influenced the content of the guideline
1
1
1
23.
Competing interests of guideline development group members have been recorded and addressed
5
1
7
Use of organs from donors testing positive for hepatitis B virus (HBV) may safely expand the donor pool. The American Society of Transplantation convened a multidisciplinary expert panel that reviewed the existing literature and developed consensus recommendations for recipient management following the use of organs from HBV positive donors. Transmission risk is highest with liver donors and significantly lower with non-liver (kidney and thoracic) donors. Antiviral prophylaxis significantly reduces the rate of transmission to liver recipients from isolated HBV core antibody positive (anti-HBc+) donors. Organs from anti-HBc+ donors should be considered for all adult transplant candidates after an individualized assessment of the risks and benefits and appropriate patient consent. Indefinite antiviral prophylaxis is recommended in liver recipients with no immunity or vaccine immunity but not in liver recipients with natural immunity. Antiviral prophylaxis may be considered for up to 1 year in susceptible non-liver recipients but is not recommended in immune non-liver recipients. Although no longer the treatment of choice in patients with chronic HBV, lamivudine remains the most cost-effective choice for prophylaxis in this setting. Hepatitis B immunoglobulin is not recommended.
Mr Simon Knight, Centre for Evidence in Transplantation, The Royal College of Surgeons of England.
Methodological Appraisers:
Rhiannon Deierhoi Reed, University of Alabama at Birmingham, Comprehensive Transplant Institute, USA
Katriona O'Donoghue, Centre for Evidence in Transplantation, The Royal College of Surgeons of England
Overall Guideline Assessment:
★★★★★★☆ (6 of 7)
Appraiser 1
Appraiser 2
Appraiser 3
6
6
6
Recommendation for future use
Appraiser 1
Appraiser 2
Appraiser 3
Yes
Yes
Yes
Domain 1 - Scope and Purpose
96%
Appraiser 1
Appraiser 2
Appraiser 3
1.
The overall objective(s) of the guideline is (are) specifically described
6
7
7
2.
The health question(s) covered by the guideline is (are) specifically described
6
7
7
3.
The population (patients, public, etc.) to whom the guideline is meant to apply is specifically described
7
7
7
Domain 2 - Stakeholder Involvement
48%
Appraiser 1
Appraiser 2
Appraiser 3
4.
The guideline development group includes individuals from all the relevant professional groups
4
7
7
5.
The views and preferences of the target population (patients, public, etc.) have been sought
1
1
1
6.
The target users of the guideline are clearly defined
2
7
5
Domain 3 - Rigour of Development
85%
Appraiser 1
Appraiser 2
Appraiser 3
7.
Systematic methods were used to search for evidence
5
7
5
8.
The criteria for selecting the evidence are clearly described
4
5
4
9.
The strengths and limitations of the body of evidence are clearly described
6
7
7
10.
The methods for formulating the recommendations are clearly described
6
5
7
11.
The health benefits, side effects, and risks have been considered in formulating the recommendations
5
7
7
12.
There is an explicit link between the recommendations and the supporting evidence
7
7
7
13.
The guideline has been externally reviewed by experts prior to its publication
5
7
7
14.
A procedure for updating the guideline is provided
7
7
6
Domain 4 - Clarity of Presentation
94%
Appraiser 1
Appraiser 2
Appraiser 3
15.
The recommendations are specific and unambiguous
6
7
7
16.
The different options for management of the condition or health issue are clearly presented
5
7
7
17.
Key recommendations are easily identifiable
7
7
7
Domain 5 - Applicability
19%
Appraiser 1
Appraiser 2
Appraiser 3
18.
The guideline describes facilitators and barriers to its application
2
2
1
19.
The guideline provides advice and/or tools on how the recommendations can be put into practice
2
2
1
20.
The potential resource implications of applying the recommendations have been considered
2
2
1
21.
The guideline presents monitoring and/ or auditing
4
6
1
Domain 6 - Editorial Independence
89%
Appraiser 1
Appraiser 2
Appraiser 3
22.
The views of the funding body have not influenced the content of the guideline
4
7
7
23.
Competing interests of guideline development group members have been recorded and addressed
6
7
7
It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.
Mr Simon Knight, Centre for Evidence in Transplantation, The Royal College of Surgeons of England.
Methodological Appraisers:
Anam Ayaz-Shah, Centre for Evidence in Transplantation, The Royal College of Surgeons of England
Katriona O'Donoghue, Centre for Evidence in Transplantation, The Royal College of Surgeons of England
Overall Guideline Assessment:
★★★☆☆☆☆ (3 of 7)
Appraiser 1
Appraiser 2
Appraiser 3
4
3
3
Recommendation for future use
Appraiser 1
Appraiser 2
Appraiser 3
Yes with modifications
No
Yes with modifications
Domain 1 - Scope and Purpose
85%
Appraiser 1
Appraiser 2
Appraiser 3
1.
The overall objective(s) of the guideline is (are) specifically described
7
7
6
2.
The health question(s) covered by the guideline is (are) specifically described
6
7
5
3.
The population (patients, public, etc.) to whom the guideline is meant to apply is specifically described
6
7
4
Domain 2 - Stakeholder Involvement
30%
Appraiser 1
Appraiser 2
Appraiser 3
4.
The guideline development group includes individuals from all the relevant professional groups
5
6
3
5.
The views and preferences of the target population (patients, public, etc.) have been sought
1
1
1
6.
The target users of the guideline are clearly defined
4
2
2
Domain 3 - Rigour of Development
16%
Appraiser 1
Appraiser 2
Appraiser 3
7.
Systematic methods were used to search for evidence
1
1
1
8.
The criteria for selecting the evidence are clearly described
1
1
1
9.
The strengths and limitations of the body of evidence are clearly described
1
3
3
10.
The methods for formulating the recommendations are clearly described
2
1
1
11.
The health benefits, side effects, and risks have been considered in formulating the recommendations
5
4
2
12.
There is an explicit link between the recommendations and the supporting evidence
5
3
2
13.
The guideline has been externally reviewed by experts prior to its publication
1
4
1
14.
A procedure for updating the guideline is provided
1
1
1
Domain 4 - Clarity of Presentation
61%
Appraiser 1
Appraiser 2
Appraiser 3
15.
The recommendations are specific and unambiguous
5
6
5
16.
The different options for management of the condition or health issue are clearly presented
5
5
4
17.
Key recommendations are easily identifiable
5
2
5
Domain 5 - Applicability
17%
Appraiser 1
Appraiser 2
Appraiser 3
18.
The guideline describes facilitators and barriers to its application
2
3
3
19.
The guideline provides advice and/or tools on how the recommendations can be put into practice
2
1
1
20.
The potential resource implications of applying the recommendations have been considered
2
4
1
21.
The guideline presents monitoring and/ or auditing
3
1
1
Domain 6 - Editorial Independence
39%
Appraiser 1
Appraiser 2
Appraiser 3
22.
The views of the funding body have not influenced the content of the guideline
1
2
1
23.
Competing interests of guideline development group members have been recorded and addressed
6
7
3
In February 2013, the Organ Procurement and Transplantation Network mandated that transplant centers perform screening of living kidney donors prior to transplantation for Strongyloides, Trypanosoma cruzi and West Nile virus (WNV) infection if the donor is from an endemic area. However, specific guidelines for screening were not provided, such as the optimal testing modalities, timing of screening prior to donation and the appropriate selection of donors. In this regard, the American Society of Transplantation Infectious Diseases Community of Practice, together with disease-specific experts, has developed this viewpoint document to provide guidance for the testing of live donors for Strongyloides, T. cruzi and WNV infection, specifically identifying at-risk populations and testing algorithms, including advantages, limitations and interpretation of results.
Mr Simon Knight, Centre for Evidence in Transplantation, The Royal College of Surgeons of England.
Methodological Appraisers:
Rhiannon Deierhoi Reed, University of Alabama at Birmingham, Comprehensive Transplant Institute, USA
Katriona O'Donoghue, Centre for Evidence in Transplantation, The Royal College of Surgeons of England
Overall Guideline Assessment:
★★★★★★☆ (6 of 7)
Appraiser 1
Appraiser 2
Appraiser 3
6
7
4
Recommendation for future use
Appraiser 1
Appraiser 2
Appraiser 3
Yes
Yes
Yes with modifications
Domain 1 - Scope and Purpose
91%
Appraiser 1
Appraiser 2
Appraiser 3
1.
The overall objective(s) of the guideline is (are) specifically described
7
7
7
2.
The health question(s) covered by the guideline is (are) specifically described
6
7
7
3.
The population (patients, public, etc.) to whom the guideline is meant to apply is specifically described
5
7
5
Domain 2 - Stakeholder Involvement
50%
Appraiser 1
Appraiser 2
Appraiser 3
4.
The guideline development group includes individuals from all the relevant professional groups
4
5
5
5.
The views and preferences of the target population (patients, public, etc.) have been sought
1
2
1
6.
The target users of the guideline are clearly defined
6
7
5
Domain 3 - Rigour of Development
58%
Appraiser 1
Appraiser 2
Appraiser 3
7.
Systematic methods were used to search for evidence
1
5
1
8.
The criteria for selecting the evidence are clearly described
1
3
1
9.
The strengths and limitations of the body of evidence are clearly described
6
5
7
10.
The methods for formulating the recommendations are clearly described
2
7
4
11.
The health benefits, side effects, and risks have been considered in formulating the recommendations
6
7
7
12.
There is an explicit link between the recommendations and the supporting evidence
6
7
7
13.
The guideline has been externally reviewed by experts prior to its publication
4
7
7
14.
A procedure for updating the guideline is provided
1
5
1
Domain 4 - Clarity of Presentation
96%
Appraiser 1
Appraiser 2
Appraiser 3
15.
The recommendations are specific and unambiguous
7
7
7
16.
The different options for management of the condition or health issue are clearly presented
6
7
7
17.
Key recommendations are easily identifiable
7
6
7
Domain 5 - Applicability
18%
Appraiser 1
Appraiser 2
Appraiser 3
18.
The guideline describes facilitators and barriers to its application
2
2
1
19.
The guideline provides advice and/or tools on how the recommendations can be put into practice
1
2
1
20.
The potential resource implications of applying the recommendations have been considered
2
2
1
21.
The guideline presents monitoring and/ or auditing
4
6
1
Domain 6 - Editorial Independence
86%
Appraiser 1
Appraiser 2
Appraiser 3
22.
The views of the funding body have not influenced the content of the guideline
4
7
6
23.
Competing interests of guideline development group members have been recorded and addressed
6
7
7
OBJECTIVE:
To update the 2010 recommendations on the evaluation and management of renal disease in HIV-infected patients.
METHODS:
This document was approved by a panel of experts from the AIDS Working Group (GESIDA) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Nephrology (S.E.N.), and the Spanish Society of Clinical Chemistry and Molecular Pathology (SEQC). The quality of evidence and the level of recommendation were evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.
RESULTS:
The basic renal work-up should include measurements of serum creatinine, estimated glomerular filtration rate by CKD-EPI, Urine protein-to-creatinine ratio, and urinary sediment. Tubular function tests should include determination of serum phosphate levels and urine dipstick for glucosuria. In the absence of abnormal values, renal screening should be performed annually. In patients treated with tenofovir or with risk factors for chronic kidney disease (CKD), more frequent renal screening is recommended. In order to prevent disease progression, potentially nephrotoxic antiretroviral drugs are not recommended in patients with CKD or risk factors for CKD. The document advises on the optimal time for referral of a patient to the nephrologist and provides indications for renal biopsy. The indications for and evaluation and management of dialysis and renal transplantation are also addressed.
CONCLUSIONS:
Renal function should be monitored in all HIV-infected patients. The information provided in this document should enable clinicians to optimize the evaluation and management of HIV-infected patients with renal disease.
Mr Simon Knight, Centre for Evidence in Transplantation, The Royal College of Surgeons of England.
Methodological Appraisers:
Anam Ayaz-Shah, Centre for Evidence in Transplantation, The Royal College of Surgeons of England
Katriona O'Donoghue, Centre for Evidence in Transplantation, The Royal College of Surgeons of England
Overall Guideline Assessment:
★★★☆☆☆☆ (3 of 7)
Appraiser 1
Appraiser 2
Appraiser 3
4
4
2
Recommendation for future use
Appraiser 1
Appraiser 2
Appraiser 3
Yes with modifications
Yes with modifications
No
Domain 1 - Scope and Purpose
37%
Appraiser 1
Appraiser 2
Appraiser 3
1.
The overall objective(s) of the guideline is (are) specifically described
2
2
2
2.
The health question(s) covered by the guideline is (are) specifically described
3
6
3
3.
The population (patients, public, etc.) to whom the guideline is meant to apply is specifically described
4
4
3
Domain 2 - Stakeholder Involvement
15%
Appraiser 1
Appraiser 2
Appraiser 3
4.
The guideline development group includes individuals from all the relevant professional groups
5
3
1
5.
The views and preferences of the target population (patients, public, etc.) have been sought
1
1
1
6.
The target users of the guideline are clearly defined
2
2
1
Domain 3 - Rigour of Development
27%
Appraiser 1
Appraiser 2
Appraiser 3
7.
Systematic methods were used to search for evidence
2
1
1
8.
The criteria for selecting the evidence are clearly described
2
1
1
9.
The strengths and limitations of the body of evidence are clearly described
5
7
3
10.
The methods for formulating the recommendations are clearly described
2
1
1
11.
The health benefits, side effects, and risks have been considered in formulating the recommendations
6
6
2
12.
There is an explicit link between the recommendations and the supporting evidence
6
7
3
13.
The guideline has been externally reviewed by experts prior to its publication
1
1
1
14.
A procedure for updating the guideline is provided
1
1
1
Domain 4 - Clarity of Presentation
76%
Appraiser 1
Appraiser 2
Appraiser 3
15.
The recommendations are specific and unambiguous
6
7
4
16.
The different options for management of the condition or health issue are clearly presented
5
6
5
17.
Key recommendations are easily identifiable
6
7
4
Domain 5 - Applicability
8%
Appraiser 1
Appraiser 2
Appraiser 3
18.
The guideline describes facilitators and barriers to its application
2
1
1
19.
The guideline provides advice and/or tools on how the recommendations can be put into practice
2
1
1
20.
The potential resource implications of applying the recommendations have been considered
3
1
1
21.
The guideline presents monitoring and/ or auditing
3
1
1
Domain 6 - Editorial Independence
39%
Appraiser 1
Appraiser 2
Appraiser 3
22.
The views of the funding body have not influenced the content of the guideline
1
2
1
23.
Competing interests of guideline development group members have been recorded and addressed
6
6
4
The human BK polyomavirus (BKV) is the major cause of polyomavirus-associated nephropathy (PyVAN) putting 1-15% of kidney transplant patients at risk of premature allograft failure, but is less common in other solid organ transplants. Because effective antiviral therapies are lacking, screening kidney transplant patients for BKV replication in urine and blood has become the key recommendation to guide the reduction of immunosuppression in patients with BKV viremia. This intervention allows for expanding BKV-specific cellular immune responses, curtailing of BKV replication in the graft, and clearance of BKV viremia in 70-90% patients. Postintervention rejection episodes occur in 8-12%, most of which are corticosteroid responsive. Late diagnosis is faced with irreversible functional decline, poor treatment response, and graft loss. Adjunct therapies such as cidofovir, leflunomide and intravenous immunoglobulins have been used, but the benefit is not documented in trials. Retransplantation after PyVAN is largely successful, but requires close monitoring for recurrent BKV viremia.
