Risk factors of delayed graft function following living donor kidney transplantation: A meta-analysis

IF 1.6 4区医学 Q4 IMMUNOLOGY Transplant immunology Pub Date : 2024-07-23 DOI:10.1016/j.trim.2024.102094

Pande Made Wisnu Tirtayasa , Gerhard Reinaldi Situmorang , Gede Wirya Kusuma Duarsa , Gede Wira Mahadita , Tanaya Ghinorawa , Etriyel Myh , Eriawan Agung Nugroho , Yenny Kandarini , Arry Rodjani , Nur Rasyid

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Abstract

Introduction

Delayed graft function (DGF) is a common condition that necessitates dialysis during the first week after transplantation. Although DGF rarely occurs following living-donor kidney transplantation (LDKT), it may eventually lead to acute or chronic graft rejection. This study aimed to assess the risk factors for DGF in patients who underwent LDKT.

Methods

A systematic review and meta-analysis of studies published before August 2022 was conducted using the PubMed, Science Direct, Cochrane, and Directory of Open Access Journal (DOAJ) databases. The review included studies that assessed the incidence of DGF following LDKT, and examined its risk factors, while excluding studies involving deceased donors. Potential risk factors were analyzed using pooled mean differences or odds ratios with 95% confidence intervals (CIs). Review Manager 5.3 was used for the meta-analysis.

Results

Among the 13 included studies, 3685 cases of DGF were identified in a total of 113,261 patients (3.25%). Potential risk factors for DGF following LDKT were examined across several aspects, including donor, recipient, donor/recipient relationship, and immunological and intraoperative factors. The identified risk factors included older donors (P = 0.07), male recipients (P < 0.0001), higher recipient body mass index (BMI) (P < 0.0001), non-white recipients (P < 0.0001), pre-existing diabetes (P < 0.0001), pre-existing hypertension (P = 0.01), history of dialysis (P < 0.0001), re-transplantation (P = 0.004), unrelated donor/recipient (P = 0.02), ABO incompatibility (P < 0.0001), higher panel reactive antibody (PRA) levels (P < 0.0001), utilization of right kidney (P < 0.0001), and longer cold ischemia time (CIT) (P = 0.004).

Conclusion

Several factors related to the donor, recipient, donor/recipient relationship, and immunological and intraoperative aspects were identified as potential risk factors for the development of DGF following LDKT. Addressing and optimizing these factors may improve the long-term outcomes of LDKT.

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活体肾移植后移植功能延迟的风险因素：荟萃分析

简介移植物功能延迟（DGF）是一种常见病，移植后第一周内必须进行透析。虽然活体供肾移植（LDKT）后很少出现 DGF，但它最终可能导致急性或慢性移植物排斥反应。本研究旨在评估接受活体肾移植的患者发生 DGF 的风险因素：利用PubMed、Science Direct、Cochrane和Directory of Open Access Journal（DOAJ）数据库对2022年8月之前发表的研究进行了系统回顾和荟萃分析。综述纳入了评估 LDKT 后 DGF 发生率的研究，并考察了其风险因素，但排除了涉及已故供体的研究。潜在风险因素的分析采用集合平均差或带有 95% 置信区间 (CI) 的几率比。采用Review Manager 5.3进行荟萃分析：在纳入的 13 项研究中，共发现 113,261 名患者中有 3685 例 DGF（3.25%）。对LDKT术后DGF的潜在风险因素进行了多方面的研究，包括供体、受体、供体/受体关系以及免疫和术中因素。已确定的风险因素包括年龄较大的供体（P = 0.07）、男性受体（P = 0.07）、免疫学因素（P = 0.07）和术中因素（P = 0.07）：与供体、受体、供体/受体关系以及免疫学和术中因素有关的几个因素被确定为 LDKT 术后发生 DGF 的潜在风险因素。解决并优化这些因素可改善 LDKT 的长期疗效。

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来源期刊

Transplant immunology 医学-免疫学

CiteScore

2.10

自引率

13.30%

发文量

198

审稿时长

48 days

期刊介绍： Transplant Immunology will publish up-to-date information on all aspects of the broad field it encompasses. The journal will be directed at (basic) scientists, tissue typers, transplant physicians and surgeons, and research and data on all immunological aspects of organ-, tissue- and (haematopoietic) stem cell transplantation are of potential interest to the readers of Transplant Immunology. Original papers, Review articles and Hypotheses will be considered for publication and submitted manuscripts will be rapidly peer-reviewed and published. They will be judged on the basis of scientific merit, originality, timeliness and quality.