Systematic Review of Preservation Solutions for Static Cold Storage of Kidneys
Posted by John O'Callaghan on October 5, 2011
We have recently completed a systematic review of preservation solutions for the static cold storage of kidney allografts (this was presented at the recent ESOT meeting and has been accepted for publication subject to satisfactory revision). We used MEDLINE, EMBASE, the Cochrane Library and the Transplant Library to perform the literature search. Searches combined MeSH and EMTREE keywords with free-text aliases for the preservation solutions. No date or language limits were applied. Inclusion criteria specified any comparative, prospective study of preservation solutions for cadaveric renal allografts.
15 trials with a total of 3,584 kidneys were included (10 RCTs and 5 Non-RCTS). We found that the risk of DGF is increased with EC stored kidneys when compared to both UW and HTK in the largest, best quality RCTs. On the basis of the 3 RCTs that compared UW with Celsior and 2 that compared UW with HTK, we concluded that these 3 solutions are associated with a comparable risk of DGF. We were able to combine the results for comparisons of UW and Celsior in a fixed effects meta-analysis to demonstrate that the risk of DGF was equal (RR=0.97, CI= 0.76-1.23, p=0.79).
There does not appear to be support for the use of one of these 3 solutions over another on the basis of cost as prices per litre are similar, as are the recommended flush volumes. Most surprisingly, there has been no RCT comparing hypertonic citrate (HOC) for renal preservation to any of the solutions in use before its development, or to newer solutions such as UW and HTK. Overall, the level of available evidence was low and a limited amount of prospective evidence was available. Furthermore the methodological quality of most of the trials that met the inclusion criteria was poor. We are now examining the evidence for preservation methods in non-renal abdominal organs.
Prospective registration of systematic reviews – the PROSPERO intiative
Posted by Simon Knight on April 23, 2011
In the world of randomised controlled trials (RCTs), a number of initiatives have existed for some time to attempt to improve methodological quality and reporting. Amongst the most important of these have been the CONSORT statement for the reporting of RCTs, and initiatives for the prospective registration of clinical trials such as the ISRCTN. More recently, efforts have extended to the reporting of systematic reviews, with the PRISMA statement mirroring the CONSORT statement for the reporting of systematic reviews. The Cochrane Collaboration have been providing tools and support for health care researchers undertaking systematic reviews for some time, including the registration of review protocols, but until now there has been no attempt to mirror the ISRCTN database in prospectively registering all systematic reviews, whether Cochrane reviews or otherwise.
Now the Centre for Reviews and Dissemination at the National Institute for Health Research have begun an initiative to prospectively register systematic reviews in an international register (PROSPERO). Registration is free and there is a structured minimum dataset required for registration of a review protocol that ensures that standards are met. Registered trials are given a unique identifier.
Prospective registration of systematic reviews is important for a number of reasons. Most importantly, it means that any deviation for the published protocol can be questioned and must be explained, reducing the risk of bias caused by modification of the review protocol during the course of the review process. It also provides an online database of reviews in progress to prevent duplication of efforts or to enable other researchers to identify in-progress reviews relevant to their field. The structured format of the protocol helps to ensure that the finished review will adhere to the PRISMA guidelines for reporting of reviews.
We will be using the PROSPERO site in future to prospectively register our reviews here at the CET, and would encourage all researchers in the field of evidence based medicine to support this initiative. It is entirely possible that at some point in the future, as with RCTs, journal editors will require evidence of a prospectively published public protocol for the review before publication is considered.
Systematic review of Tuberculosis prophylaxis published in Transplantation
Posted by Simon Knight on November 1, 2010
A systematic review and meta-analysis of the use of tuberculosis prophylaxis in renal transplant recipients, led by research fellow Andy Currie has been published in Transplantation.
The full article can be found on the Transplantation website.