Table 3. The top 25 ranked questions from the prioritisation survey.
| Question | Rank | |||
|---|---|---|---|---|
| Overall | Patients/carers | Professionals | Donors | |
| Which treatments work best to prolong the life of the kidney transplant (for example different immunosuppression, blood pressure control)? | 1 | 1 | 1 | 2 |
| Is there a reliable way for us to assess the suitability of individual organs for transplantation, and to predict outcomes? | 2 | 13 | 2 (=) | 1 |
| What is the best way to treat vascular or antibody mediated rejection? | 3 | 8 | 2 (=) | 12 (=) |
| How can we prevent sensitisation in patients with a failing transplant, to improve their chances of another successful transplant? (e.g. removal of the transplant, withdrawal of immunosuppressive medicines or continuation of these medicines?) | 4 | 7 | 6 | 5 |
| How can immunosuppression be personalised to the individual patient to improve the results of transplantation? | 5 | 4 (=) | 5 | 15 (=) |
| What is the best combination of immunosuppressive drugs following kidney transplantation (for example azathioprine or mycophenolate, belatacept, generic or proprietary (brand-name) drugs)? | 6 | 2 | 11 | 12 (=) |
| How can we match organs to recipients to ensure the best overall outcomes (for example by age, nephron dosing)? | 7 | 4 (=) | 7 | 6 |
| What tests are required to determine whether a transplant is a suitable option for a patient? | 8 | 6 | 8 | 20 (=) |
| For which patients is transplantation not suitable (considering factors such as age, body mass index, history of cancer, co-morbidities)? | 9 | 24 | 4 | 24 (=) |
| What is the best method of sharing deceased donor kidneys to ensure fair access to all age groups whilst minimising waiting times? | 10 | 11 (=) | 17 | 7 |
| How can we ensure fair and equal access to transplantation across the UK? | 11 | 9 | 16 | 15 (=) |
| Can we improve monitoring of the level of immunosuppression to achieve better balance between risk of rejection and side effects (for example T-cell or B-cell ELISPOT, point-of-care tacrolimus monitoring, MMF monitoring)? | 12 | 17 (=) | 12 (=) | 22 |
| What techniques to preserve and transport the kidney before transplantation allow increased preservation times and/or improve results (for example machine perfusion, normothermic reconditioning)? | 13 | 3 | 22 | 14 |
| What are the long-term health risks to the living kidney donor? | 14 | 22 | 12 (=) | 19 |
| What approaches improve outcomes in adolescent and young adult kidney transplant recipients? | 15 | 17 (=) | 14 | 30 |
| Does routine screening for and treatment of donor-specific antibodies improve outcomes? What is the most effective treatment? | 16 | 25 | 9 | 28 |
| How can we increase the number of potential living donors coming forward, and the proportion proceeding to donation? | 17 | 10 | 23 | 3 |
| How can we improve transplant rates in highly-sensitised patients? | 18 | 28 | 10 | 18 |
| Which combinations of immunosuppressive drugs can minimise side effects in kidney transplant recipients (such as infections, diarrhoea, malignancy)? | 19 | 11 (=) | 19 | 29 |
| How can we encourage tolerance to the transplant to prevent or reduce the need for immunosuppression (for example by use of T-regulatory cells, induction of haemoxygenase 1)? | 20 | 20 | 20 | 10 |
| For blood group incompatible transplants, which treatments most effectively reduce antibody levels and improve the safety and outcomes of the operation? | 21 | 21 | 21 | 26 |
| Can bioengineered organs be developed to be as safe and effective as human-to-human transplants? How can this be achieved? | 22 | 16 | 25 | 9 |
| Can adding substances to the storage or perfusion solution for the kidney improve preservation and overall results (for example oxygenation, EPO, complement inhibitors, stem cells, scavenger molecules)? | 23 | 19 | 26 | 24 (=) |
| What is the best way of educating patients about transplantation before their operation? | 24 | 15 | 28 | 20 (=) |
| How do we prevent the original cause of kidney failure returning (for example glomerulonephritis) following kidney transplant? | 25 | 26 | 29 | 4 |
Respondents were asked to score questions on a five-point Likert scale, and the mean score within each group (patients, professionals and donors) was used to rank questions from highest to lowest score. (=) indicates questions ranked equally.