Clinical diagnosis and treatment guidelines for long-term systemic complications in kidney transplant recipients in China
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摘要: 为进一步规范肾脏移植受者远期系统并发症的诊断与治疗，中华医学会器官移植学分会发起制订《中国肾脏移植受者远期系统并发症临床诊疗指南》，组织器官移植学专家，依据现有临床指南、系统评价、病例研究、专家共识等资料，总结近年国内外肾脏移植受者远期系统并发症诊治新进展，将血液系统、中枢神经系统、心血管系统、眼、皮肤及骨质疏松并发症的诊治工作进行整合，经过多次专家研讨达成一致意见后撰写成文。全文围绕27个临床问题，形成40条推荐意见，主要涉及各个并发症的危险因素、分类分级、诊断治疗和预防等。本指南使用2009版牛津大学循证医学中心的证据分级与推荐强度标准，对每个临床问题的推荐意见强度与证据级别进行分级，希望为肾脏移植受者远期系统并发症的诊疗提供参考，全面提升临床医师的管理能力，造福肾脏移植受者。Abstract: In order to further standardize the diagnosis and treatment of long-term systemic complications in kidney transplant recipients, Branch of Organ Transplantation of Chinese Medical Association initiated the formulation of “Clinical Diagnosis and Treatment Guidelines for Long-term Systemic Complications in Kidney Transplant Recipients in China”. Experts on organ transplantation were organized to summarize and integrate the latest progress in this field based on existing clinical guidelines, systematic evaluations, case studies, expert consensus. The guideline was formed after multiple rounds of discussion and reaching a consensus which included complications of hematological system, central nervous system, cardiovascular system, ocular, cutaneous and osteoporosis disorders. The full text focuses on 27 clinical problems and forms 40 recommendations, mainly involving the risk factors, classification, diagnosis, treatment and prevention of various complications. This guideline graded the quality of evidence and the strength of recommendation for each clinical issue using 2009 Oxford Centre for Evidence-Based Medicine (OCEBM) Grading and Strength of Recommendation criteria, so as to provide reference for the diagnosis and treatment of late complications, comprehensively improve the management capacity of clinicians to benefit kidney transplant recipients.
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表 1 2009版OCEBM证据分级与推荐意见强度分级标准
Table 1. Level of evidence and recommended strength grades of OCEBM in 2009
推荐强度 证据等级 描述 A 1a 多项随机对照试验的系统评价 1b 结果可信区间小的随机对照试验 1c 显示“全或无效应”的任何证据 B 2a 队列研究的系统评价 2b 单个的队列研究（包括低质量的随机
对照试验，如失访率>20%者）2c 基于患者结局的研究 3a 病例对照研究的系统评价 3b 单个病例对照研究 C 4 病例系列报告、低质量队列研究和
低质量病例对照研究D 5 专家意见（即无临床研究支持仅依据
基础研究或临床经验的推测）
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