Research recommendations

We recommend that future research be undertaken to aid the translation of these research findings into the NHS, prioritising the development and deployment of the risk calculators into the GP electronic health record software. These steps may include development of thresholds at which to change the current monitoring intervals between blood tests, evaluation of clinical and cost-effectiveness of risk-stratified monitoring, knowledge mobilisation exercise and continued long-term surveillance of adverse effects of risk-stratified monitoring. It would also be important to develop automated software applications to aid risk-stratified monitoring. Future research should also consider validating the risk prediction model in other nations outside of the UK. Due to small number of patients, it was not possible to develop a validated risk score for mycophenolate and biologic discontinuation and further research in the field is needed.