Renal Transplantation


2.1. Introduction

For the 2021 Renal Transplantation Guidelines, new and relevant evidence was identified, collated and appraised through a structured assessment of the literature. Broad and comprehensive literature searches, covering the Renal Transplantation Guidelines were performed, covering a time frame between May 31st 2018 and 1st April 2020. A total of 1,202 unique records were identified, retrieved and screened for relevance. Databases searched included Medline, EMBASE, and the Cochrane Libraries. Detailed search strategies are available online:

For each recommendation within the guidelines there is an accompanying online strength rating form which includes the assessment of the benefit to harms ratio and patients’ preferences for each recommendation. The strength rating forms draw on the guiding principles of the GRADE methodology but do not purport to be GRADE [1,2]. Each strength rating form addresses a number of key elements namely:

  1. the overall quality of the evidence which exists for the recommendation, references used in this text are graded according to a classification system modified from the Oxford Centre for Evidence-Based Medicine Levels of Evidence [3];
  2. the magnitude of the effect (individual or combined effects);
  3. the certainty of the results (precision, consistency, heterogeneity and other statistical or study related factors);
  4. the balance between desirable and undesirable outcomes;
  5. the impact of patient values and preferences on the intervention;
  6. the certainty of those patient values and preferences.

These key elements are the basis which panels use to define the strength rating of each recommendation. The strength of each recommendation is represented by the words ‘strong’ or ‘weak’ [4]. The strength of each recommendation is determined by the balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence (including certainty of estimates), and nature and variability of patient values and preferences.

Additional information can be found in the general Methodology section of this print, and online at the EAU website; A list of associations endorsing the EAU Guidelines can also be viewed online at the above address.

2.2. Review and future goals

This document was subject to independent peer review prior to publication in 2017. Publications ensuing from systematic reviews have all been peer reviewed.

The results of ongoing systematic reviews will be included in the 2022 update of the Renal Transplantation Guidelines. Ongoing systematic reviews include:

  1. What is the best treatment for symptomatic obstructive benign prostatic enlargement in renal transplantation patients [5]?
  2. For patients with kidney graft stones, does surgical treatment provide better stone free rates than external shock wave lithotripsy [6]?