The effectiveness and cost-effectiveness of methods of storing donated kidneys from deceased donors: a systematic review and economic model

Bond, Mary; Pitt, Martin; Akoh, Jacob A; Moxham, T; Hoyle, Martin; Anderson, Rob

doi:10.3310/hta13380

Cited by 74 publications

(51 citation statements)

References 246 publications

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“…The split between these transitions is age dependent (as the likelihood of pre-emptive retransplantation decreases with advancing age; Table 152). The probability that a KTR in each age range is suitable for retransplantation was taken from table 32 of Bond et al, 384 which was, in turn, estimated from a figure in chapter 5 of the UK Renal Registry Eighth Annual Report. 385 It was then assumed that 20% of these KTRs would receive a pre-emptive retransplantation.…”

Section: Peninsula Technology Assessment Group Economic Assessmentmentioning

confidence: 99%

Immunosuppressive therapy for kidney transplantation in adults: a systematic review and economic model

Jones-Hughes

Snowsill

Haasova

et al. 2016

Health Technol Assess

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BackgroundEnd-stage renal disease is a long-term irreversible decline in kidney function requiring renal replacement therapy: kidney transplantation, haemodialysis or peritoneal dialysis. The preferred option is kidney transplantation, followed by immunosuppressive therapy (induction and maintenance therapy) to reduce the risk of kidney rejection and prolong graft survival.ObjectivesTo review and update the evidence for the clinical effectiveness and cost-effectiveness of basiliximab (BAS) (Simulect®, Novartis Pharmaceuticals UK Ltd) and rabbit anti-human thymocyte immunoglobulin (rATG) (Thymoglobulin®, Sanofi) as induction therapy, and immediate-release tacrolimus (TAC) (Adoport®, Sandoz; Capexion®, Mylan; Modigraf®, Astellas Pharma; Perixis®, Accord Healthcare; Prograf®, Astellas Pharma; Tacni®, Teva; Vivadex®, Dexcel Pharma), prolonged-release tacrolimus (Advagraf®Astellas Pharma), belatacept (BEL) (Nulojix®, Bristol-Myers Squibb), mycophenolate mofetil (MMF) (Arzip®, Zentiva; CellCept®, Roche Products; Myfenax®, Teva), mycophenolate sodium (MPS) (Myfortic®, Novartis Pharmaceuticals UK Ltd), sirolimus (SRL) (Rapamune®, Pfizer) and everolimus (EVL) (Certican®, Novartis) as maintenance therapy in adult renal transplantation.MethodsClinical effectiveness searches were conducted until 18 November 2014 in MEDLINE (via Ovid), EMBASE (via Ovid), Cochrane Central Register of Controlled Trials (via Wiley Online Library) and Web of Science (via ISI), Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and Health Technology Assessment (The Cochrane Library via Wiley Online Library) and Health Management Information Consortium (via Ovid). Cost-effectiveness searches were conducted until 18 November 2014 using a costs or economic literature search filter in MEDLINE (via Ovid), EMBASE (via Ovid), NHS Economic Evaluation Database (via Wiley Online Library), Web of Science (via ISI), Health Economic Evaluations Database (via Wiley Online Library) and the American Economic Association’s electronic bibliography (via EconLit, EBSCOhost). Included studies were selected according to predefined methods and criteria. A random-effects model was used to analyse clinical effectiveness data (odds ratios for binary data and mean differences for continuous data). Network meta-analyses were undertaken within a Bayesian framework. A new discrete time–state transition economic model (semi-Markov) was developed, with acute rejection, graft function (GRF) and new-onset diabetes mellitus used to extrapolate graft survival. Recipients were assumed to be in one of three health states: functioning graft, graft loss or death.ResultsEighty-nine randomised controlled trials (RCTs), of variable quality, were included. For induction therapy, no treatment appeared more effective than another in reducing graft loss or mortality. Compared with placebo/no induction, rATG and BAS appeared more effective in reducing biopsy-proven acute rejection (BPAR) and BAS appeared more effective at improving GRF. For maintenance therapy, no treatment was better for all outcomes and no treatment appeared most effective at reducing graft loss. BEL + MMF appeared more effective than TAC + MMF and SRL + MMF at reducing mortality. MMF + CSA (ciclosporin), TAC + MMF, SRL + TAC, TAC + AZA (azathioprine) and EVL + CSA appeared more effective than CSA + AZA and EVL + MPS at reducing BPAR. SRL + AZA, TAC + AZA, TAC + MMF and BEL + MMF appeared to improve GRF compared with CSA + AZA and MMF + CSA. In the base-case deterministic and probabilistic analyses, BAS, MMF and TAC were predicted to be cost-effective at £20,000 and £30,000 per quality-adjusted life-year (QALY). When comparing all regimens, only BAS + TAC + MMF was cost-effective at £20,000 and £30,000 per QALY.LimitationsFor included trials, there was substantial methodological heterogeneity, few trials reported follow-up beyond 1 year, and there were insufficient data to perform subgroup analysis. Treatment discontinuation and switching were not modelled.Future workHigh-quality, better-reported, longer-term RCTs are needed. Ideally, these would be sufficiently powered for subgroup analysis and include health-related quality of life as an outcome.ConclusionOnly a regimen of BAS induction followed by maintenance with TAC and MMF is likely to be cost-effective at £20,000–30,000 per QALY.Study registrationThis study is registered as PROSPERO CRD42014013189.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Peninsula Technology Assessment Group Economic Assessmentmentioning

confidence: 99%

Immunosuppressive therapy for kidney transplantation in adults: a systematic review and economic model

Jones-Hughes

Snowsill

Haasova

et al. 2016

Health Technol Assess

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“…HMP techniques are still open to criticism with the suggestion of increased endothelial injury, as found in a recent study of porcine livers [89], risk of trauma to the vessels and the question of cost effectiveness compared to static storage techniques [90]. Nonetheless, it appears that HMP may hold a significant advantage in reducing CI injury compared to CS techniques.…”

Section: Hypothermic Machine Perfusionmentioning

confidence: 95%

Cold Ischaemic Injury in Kidney Transplantation

Hosgood¹,

Hunter²,

Nicholson³

2012

Current Concepts in Kidney Transplantation

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“…The traditional preservation solution is a type of static cold crystalloid solution that contains impermeants to maintain osmoregulation and control edema, reactive oxygen species scavengers to prevent free radical damage, substrates to maintain energy and buffers to prevent acidosis, such as UW solution, which has become a gold standard (12). It has been reported that cold storage is a simple and effective method, which keeps the donor kidney stored for up to 24 h when the kidney is from a standard deceased donor (13).…”

Section: Discussionmentioning

confidence: 99%

Protective effect of tanshinone IIA on rat kidneys during hypothermic preservation

Zhang

et al. 2011

Mol Med Report

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Abstract. Renal preservation is a universal problem since ischemia/reperfusion (I/R) injury remains an unresolved issue during the procedure of renal transplantation. Tanshinone IIA, one of the effective components of the traditional Chinese medicine Danshen, was reported to exhibit a variety of biochemical activities, including protection against I/R injury. Therefore, identifying the specific molecular pathway mediating tanshinone IIA protection of renal preservation would be of great value to the patients concerned. In this study, rats were divided into two groups and the kidneys were isolated and preserved in two solutions separately, one with Celsior solution and the other with tanshinone IIA additionally added to the Celsior solution. The superoxide dismutase (SOD) activity and the quantity of malonaldehyde (MDA) were measured, the expression of CHOP and caspase-12 were assessed by immunohistochemistry staining, and real-time quantitative reverse transcription-polymerase chain reaction analysis was performed after 0, 24 and 48 h of preservation. A significant increase in the activities of SOD and a decrease in the quantity of MDA were observed in the kidneys preserved with tanshinone IIA at 24 and 48 h (P<0.01). The expression of CHOP and caspase-12 was lower in the kidneys preserved with tanshinone IIA at 24 and 48 h than that in the kidneys preserved with Celsior solution alone (P<0.05). The results suggest that the supplementation of tanshinone IIA in standard Celsior solution may significantly improve long-term kidney preservation. Attenuating oxidative stress injury and decreasing endoplasmic reticulum (ER) stress-mediated apoptosis may play a role in the protection of kidney hypothermic preservation.

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The effectiveness and cost-effectiveness of methods of storing donated kidneys from deceased donors: a systematic review and economic model

Cited by 74 publications

References 246 publications

Immunosuppressive therapy for kidney transplantation in adults: a systematic review and economic model

Immunosuppressive therapy for kidney transplantation in adults: a systematic review and economic model

Cold Ischaemic Injury in Kidney Transplantation

Protective effect of tanshinone IIA on rat kidneys during hypothermic preservation

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