4.6 Review

Range and Consistency of Infection Outcomes Reported in Trials Conducted in Kidney Transplant Recipients: A Systematic Review

Journal

TRANSPLANTATION
Volume 105, Issue 12, Pages 2632-2638

Publisher

LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/TP.0000000000003723

Keywords

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Funding

  1. Australian National Health and Medical Research Council (NHMRC) Postgraduate Scholarship
  2. Microba recipient grant
  3. Metro South Research Support Scheme
  4. Royal Australasian College of Physicians (RACP) Jacquot NHMRC Research Excellence top-up award
  5. NHMRC Postgraduate Scholarship
  6. RACP Jacquot NHMRC Award for Excellence
  7. Baxter Healthcare
  8. Fresenius Medical Care
  9. Amgen
  10. Australian NHMRC Practitioner Fellowship
  11. NHMRC Research Fellowship
  12. Royal Australasian College of Physicians (Jacquot Research Establishment Award)
  13. Princess Alexandra Research Foundation
  14. CareDx
  15. NIDDK [U01 DK116042-01, R01DK102981]
  16. Otsuka
  17. Janssen
  18. GlaxoSmithKline

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This study analyzed infection outcomes reported in 102 contemporary trials conducted in kidney transplant recipients. The results showed that outcomes were frequently reported by infection site and organism, but varied widely in terms of metrics, aggregation methods, and time points. Establishment of core outcomes for infection may improve the consistency, comparability, and usefulness of trial evidence.
Background. Infection remains a leading cause of death in kidney transplant recipients. This study aimed to assess the scope and consistency of infection outcomes reported in contemporary trials conducted in kidney transplant recipients. Methods. A literature review of all randomized trials and trial protocols reporting infection outcomes in adult kidney transplant recipients was identified in the Cochrane Kidney and Transplant Specialized Register from January 2014 to July 2019. Characteristics and infection outcomes from the trials were analyzed. Results. From 102 included trials, 772 outcome measures were extracted and categorized into 216 unique measures with a median of 3.2 outcome measures per trial (range: 1-9). Measures were further grouped into 32 outcomes based on site of infection (14 outcomes) and organism (18 outcomes). The most commonly reported site-specific outcome and organism-specific outcome were systemic infection (71% trials) and cytomegalovirus infection (62% trials), respectively. Outcome metric and methods of aggregation included mean, median, proportion, proportional change, and number of patients with at least 1 episode. Across all trials, measures were assessed at 55 different time points with a range of 1-11 time points per trial. Conclusions. Infection outcomes in kidney transplant recipients were frequently reported by site and organism but varied widely in terms of outcome, metrics, method of aggregation, and time point of measurement. Establishment of core outcomes for infection based on the shared priorities of patients/caregivers and health professionals may improve the consistency, comparability, and usefulness of trial evidence.

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