Transplant Trial Watch

Cancer evaluation in the assessment of solid organ transplant candidates: A systematic review of clinical practice guidelines.

Acuna SA, Lam W, et al.

Transplantation Reviews 2017; 08: 08.

To conduct a systematic review to assess the availability, quality and consistency of clinical practice guidelines (CPGs) for cancer evaluation in the selection of solid organ transplants and characterise the current state of CPG standards.

The databases PubMed, Medline and Embase were searched as well as bibliographies of relevant literature, transplant organisations and google scholar in May 2016 for CPGs published in English for the selection of candidates for solid organ transplantation. Two researched independently screened titles, abstracts and full-texts and any disagreements were resolved by discussion. Two reviewers independently assessed CPGs using the AGREE II tool.

13 CPGs were included in the systematic review.

Measured outcomes included AGREE II domain specific scores, the level of evidence, strength of recommendations and characteristics of CPGs.

Not reported

CET Conclusions
This systematic review assesses the availability, quality, and consistency of recommendations regarding pre-transplant cancer screening in clinical practice guidelines (CPGs) for the selection of solid organ transplant candidates. The review was prospectively registered with PROSPERO. The comprehensive search identified 13 CPGs that included recommendations regarding pre-transplant cancer screening for kidney transplantation (n=8), liver transplantation (n=2), heart transplantation (n=2) and lung transplantation (n=1). The quality of CPGs was assessed by two reviewers using the Appraisal of Guidelines for Research and Evaluation (AGREE) tool although the background of the reviewers was not described. Disagreement between reviewers of >2 points per question was discussed and resolved by discussion but it was not reported how many scores were modified following discussion. The AGREE tool consists of scoring 24 questions across six domains and in addition reviewers should complete the overall guideline assessment, i.e. a score for the overall quality of the guideline and whether they would recommend the use of guidelines (yes, yes with modifications or no) however the reviewers did not complete the overall guideline assessment. The review showed that the quality of CPGs regarding is generally insufficient and the recommendations are not consistent. Seven guidelines recommend cancer screening as recommended for the general population. None of the guidelines provided guidance on how often screening should repeated while on the waiting list and stakeholders such as oncologists or patients were not involved in the development of any of the CPGs. The AGREE scores varied widely between CPGs and between domains. Most recommendations were based on expert opinions rather than on evidence. The strength of the recommendations was only reported for two guidelines and most CPGs did not report the level of evidence.

Quality notes
Quality assessment not appropriate

Trial registration
PROSPERO - 42016042344

Funding source
Non-industry funded