The full list of unanswered research questions.

The full list of unanswered research questions identified during the PSP process are provided below.

Recipient assessment

In potential kidney transplant candidates, what is the best method for assessing and modifying cardiovascular risk? Does this differ for diabetic/non-diabetic patients?
In potential kidney transplant candidates, what are the optimal investigations required to assess suitability?
In patients on the kidney transplant waiting list, which investigations are required for ongoing assessment, and how frequently?
In potential kidney transplant recipients, what are the absolute exclusion criteria (e.g. age, body mass index, history of malignancy, co-morbidities)?
In kidney transplant candidates on the waiting list, what investigations are required on admission for transplant?

Recipient education

In potential kidney transplant recipients, what is the best method for delivering pre-transplant education?

Access to the waiting list and organ allocation

In potential kidney transplant recipients, how can we ensure fair and equal access to transplantation across the UK?
In kidney transplantation, what is the optimum timing for a pre-emptive transplant?
In potential kidney transplant candidates, what is the best method of deceased donor kidney allocation to ensure fair access to all age groups whilst minimising waiting times and cold ischaemia
In deceased donor kidney transplantation, is there a robust way in which we can assess the suitability of individual organs for transplantation and predict outcomes (including DCD/ECD kidneys)?
In deceased donor kidney transplantation, how can we ensure that organs are effectively matched to recipients (e.g. age, nephron dosing)?
In patients on the kidney transplant waiting list, does increased patient choice (as to the organs they will accept) improve outcomes and/or access?
In deceased donor kidney transplant recipients, in what circumstances does the recipient benefit from dual as compared to single kidney transplant?

Highly sensitised recipients

In highly sensitised patients on the kidney transplant transplant waiting list, is it possible to desensitise patients to improve the chances of transplantation?
In highly sensitised patients on the kidney transplant waiting list, how can we improve transplant rates?
In highly sensitised kidney transplant recipients, how can we improve outcomes?

Organ preservation/reconditioning

In kidney transplant recipients, what techniques to preserve, transport or recondition the kidney can lead to increased preservation times and/or improved outcomes? (e.g. normothermic/hypothermic machine perfusion, normothermic reconditioning, oxygenation)
In kidney transplant recipients, can the addition of substances to the storage solution improve preservation and outcomes? (e.g. oxygenation, EPO, complement inhibitors, stem cells, scavenger molecules)?

Live donor transplantation

In the assessment of potential living donors, how can we speed up the assessment process to ensure more timely transplant?
For potential living donors, what should be the absolute exclusion criteria for donation (e.g. age, BMI)?
In potential living donors, what are the necessary investigations to ensure safe donation whilst minimising the assessment time?
When there is more than one potential living donor for an individual, what criteria should be used for selecting the donor to ensure optimum outcome for both donor and recipient?
In living donor transplantation, which interventions increase the number of potential donors coming forward, and the proportion proceeding to donation?
In live kidney donors, does laparoscopic donor nephrectomy improve outcomes compared to open or mini-incision nephrectomy?
Following living kidney donation, what interventions reduce the time for recovery (e.g.methods of pain relief)?
Following living kidney donation, what are the long-term health risks to the donor?
Following living kidney donation, are there any long-term psychological consequences to the donor?
Following living donor kidney transplantation, should donors avoid certain medications (e.g. NSAIDS)?
Following living kidney donation, are the outcomes from pregnancy the same as in non-donors?
Following living kidney donation, what is the best model for donor follow-up?
In living donors entering the paired exchange scheme, how can we speed up the donation process?
In living kidney donation, would entering all donor-recipient pairs into at least one round of the paired exchange scheme increase donation rates and improve matching?

Non-directed donation

Do the medical and psychological impacts in non-directed living donors differ from those in directed donors?
What interventions could increase the number of non-directed donors putting themselves forwards and proceeding to donation?
What is the social impact of non-directed donation outside of the donor, recipients and their immediate families?
What is the most effective way to allocate non-directly donated kidneys to maximise outcomes?
Would reimbursement of non-directed living kidney donors increase donation rates without leading to exploitation?

Tissue typing/immunology

In deceased donor kidney transplant recipients, what effect would more specific tissue typing have on waiting times and outcomes? (e.g. HLA-DQA, DPA and DBP matching)
In kidney transplant recipients, how can we better assess the likely immunological response to a particular organ?

ABO/HLA incompatible transplantation

In potential recipients of blood group (ABO) incompatible kidney transplants, which interventions reduce antibody titres and improve the safety and results of transplantation?
In potential recipients of HLA incompatible kidney transplants, what level of HLA antibody is safe to transplant across? What factors or characteristics affect this level?

Donor specific antibodies

In kidney transplant recipients, which strategies prevent the formation of donor specific antibodies?
In kidney transplant recipients, does routine screening for and treatment of donor-specific antibodies improve outcomes? What is the most effective intervention?

Surgical technique/intraoperative management

In kidney transplant recipients, does laparoscopic implantation improve outcomes compared to open implantation?
In women with at least one normal delivery, does transvaginal kidney transplantation provide equivalent outcomes to open surgery?
In kidney transplant recipients, do donor or reperfusion biopsies aid organ selection and/or clinical management to improve outcomes when compared to no biopsies?
In kidney transplant recipients, what interventions at the time of transplantation improve graft outcomes?
In kidney transplant recipients, does the use of ureteric stents improve outcomes compared to no stent?
In kidney transplant recipients, what is the most effective method of analgesia for the postoperative period?
In kidney transplant recipients, what is the best regimen for intravenous fluid replacement? Does this vary by transplant type or recipient characteristics?
In kidney transplant recipients, does implantation into a structurally or functionally abnormal urinary tract affect outcomes compared to a normal urinary tract?
In kidney transplant recipients, how can the risks of future elective surgery be minimised?

Cardiovascular/metabolic complications of transplantation

In kidney transplant recipients, which cardiovascular medications improve outcomes (e.g. aspirin, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, statins)?
In kidney transplant recipients, what is the optimal blood pressure target? Is this the same as the non-transplant population?
In kidney transplant recipients, can we predict those at high risk of new-onset diabetes? What interventions can minimise this risk?
In kidney transplant recipients, how can we diagnose, prevent and/or manage renal bone disease?

Infective complications of transplantation

In kidney transplant recipients, does antibiotic prophylaxis reduce the risk of urinary tract infection compared to no prophylaxis?
In kidney transplant recipients, is screening for BK virus (with appropriate intervention) clinically- and cost-effective compared to no screening? What is the most effective intervention?
In kidney transplant recipients, what is the optimum duration of CMV prophylaxis post-transplant?

Post-transplant malignancy

In kidney transplant recipients, is screening for common malignancies clinically- and cost-effective (e.g. skin, prostate, colon, breast, cervix, post-transplant lymphoproliferative disorder)?

Acute rejection

In kidney transplant recipients, what is the best way to manage vascular or antibody mediated acute rejection?
In kidney transplant recipients with subclinical acute rejection, does active management improve outcomes compared to watchful waiting? Which intervention is most effective?
In kidney transplant recipients with acute rejection, are there biomarkers that can allow early diagnosis?
In kidney transplant recipients, what is the best way to manage acute cellular rejection?
In kidney transplant recipients, does blood transfusion increase the risk of acute rejection?

Chronic rejection/CAN/late graft loss

In kidney transplant recipients, what is the best strategy to prolong the life of the transplant kidney?

Delayed graft function

In kidney transplant recipients, is there a suitable biomarker for identifying or predicting delayed graft function?

Recurrent disease

In kidney transplant recipients, how do we prevent recurrent disease (e.g.glomeulonephritis) post-transplant?

Quality of life/psychosocial outcomes

In kidney transplant recipients, does access to psychological or psychosocial support improve outcomes?
In kidney transplant recipients with depression or anxiety, what is the best method for management?
In kidney transplant recipients, what is the best method for measuring quality of life?
In kidney transplant recipients, does recipient ethnicity affect quality of life following transplantation?

Post-transplant monitoring

In kidney transplant recipients, do routine biopsies of the transplant kidney improve outcomes compared to on-demand biopsies?
In kidney transplant recipients, what is the optimum follow-up protocol to minimise clinic visits whilst ensuring that problems are detected early?

Management of the failing transplant

In kidney transplant recipients with a failing transplant, when is the optimum time to re-list on the transplant waiting list?
In kidney transplant recipients with a failing transplant, what is the safest management strategy that minimises sensitisation - graft nephrectomy, immunosuppression withdrawal or immunosuppression continuation?

Diet and lifestyle

In kidney transplant recipients, what lifesyle factors affect outcomes (e.g. diet, exercise, alcohol, environmental hazards, weight, medications, work)?
In female kidney transplant recipients of child bearing age, what are the risks of pregnancy when compared to pregnancy in a non-transplanted individual? How long post-transplant is pregnancy safe?

Immunosuppression and tolerance

In kidney transplant recipients, what is the most effective immunosuppressive regimen (e.g. azatiohprine vs mycophenolate, belatacept, generic vs proprietary)?
In kidney transplant recipients, are generic immunosuppressive drugs as effective as proprietary (brand-name) drugs?
In kidney transplant recipients, does belatacept improve outcomes and transplant histology in kidney transplant recipients compared to mTOR inhibitor or tacrolimus-based drug combinations?
In kidney transplant recipients, which immunosuppressive regimens can minimise side effects (e.g. infections, diarrhoea, malignancy)?
In kidney transplant recipients, how can we induce tolerance to the graft to prevent or reduce the need for immunosuppression (e.g. T-regulatory cells, induction of haemoxygenase 1)?
In kidney transplant recipients, how can immunosuppression be personalised to the individual patient for optimal outcomes?
In kidney transplant recipients, can we improve monitoring of the level of immunosuppression (e.g. T-cell or B-cell ELISPOT, point-of-care tacrolimus monitoring, MMF monitoring)?
In kidney transplant recipients, what interventions improve compliance with immunosuppression?

Paediatric and adolescent transplantation

In adolescent/young adult kidney transplant recipients, what interventions improve outcomes?
In paediatric kidney transplant recipients, what are the most effective interventions to prevent sensitisation?

Artificial and bioengineered organs

In potential kidney transplant recipients, can xenotransplantation become as safe and effective as human to human transplantation?
In potential kidney transplant recipients, can bioengineered organs be developed to provide equivalent safety and efficacy as human to human transplants?