Post-transplant follow-up for kidney transplant recipients: a systematic review of clinical practice guidelines

Abstract Background Kidney transplantation is the treatment of choice for kidney failure, but long-term allograft survival remains challenging. Post-transplant follow-up is essential for monitoring allograft function and managing complications. Although clinical practice guidelines (CPGs) share broad principles, they differ in surveillance timing, frequency, and content. This review compared CPGs for kidney transplant recipients (KTRs), focusing on methodological quality, evidence base, and recommendations. Methods Journal databases, guideline repositories, and professional association websites were searched for CPGs published between January 2009 and October 2025. Methodological quality was assessed using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. Recommendations on follow-up frequency, monitoring content, and implementation were compared. Results Seven CPGs were included. All recommended intensive early monitoring followed by progressively less frequent surveillance. Differences were most evident in long-term follow-up intervals, protocol kidney allograft biopsy, immunological monitoring, and implementation tools. Most guidelines scored highly in “Scope and Purpose” and “Clarity of Presentation” but lower in “Applicability.” KDIGO had the highest methodological quality, although its earlier publication may limit incorporation of recent evidence and evolving care models. Conclusions Guidelines agree on general principles but differ in operational recommendations because of variations in resources, healthcare systems, methods, and evidence interpretation. Most follow-up frequency recommendations rely on low-quality evidence or expert consensus. Clinicians should follow local guidance, use international guidance such as KDIGO when local guidance is unavailable, and individualize follow-up according to immunological risk, allograft status, comorbidities, adherence, patient preferences, and resources, while future revisions incorporate emerging evidence from pragmatic studies.