Outcomes of kidney replacement therapies after kidney transplant failure: A systematic review and meta-analysis

IF 3.6 2区医学 Q2 IMMUNOLOGY Transplantation Reviews Pub Date : 2024-10-02 DOI:10.1016/j.trre.2024.100883

Xingge Sun , Stephen O'Neill , Helen Noble , Jia Zeng , Sarah Chanakarn Tuan , Clare McKeaveney

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Abstract

Background

Following kidney transplant failure, patients generally have three kidney replacement therapy (KRT) options: peritoneal dialysis (PD), haemodialysis (HD), or pre-emptive kidney re-transplantation. This review aims to explore KRT options after kidney transplant failure and compare clinical outcomes.

Method

This review included studies from five databases: Medline, PubMed, Embase, Cochrane, and CINAHL. The study protocol was registered at PROSPERO [CRD42024514346]. Causes of kidney transplant failure were explored. Survival and re-transplantation rates among three groups after kidney transplant failure were compared: patients starting PD (TX-PD group), patients starting HD (TX-HD group), and patients re-transplanted without bridging dialysis (TX-TX group). Causes of death were also explored. The quality of the included studies was assessed using the CASP checklist and the meta-analysis was assessed using the GRADE approach.

Results

Of 6405 articles, eight articles were included in the systematic review. Chronic damage was identified as the primary cause of kidney transplant failure. The TX-TX group had a lower mortality rate than the TX-HD group and TX-PD group, though this difference was only statistically significant in comparison to the TX-HD group (OR: 2.57; 95 % CI:1.58, 4.17; I² = 79 %; P = 0.0001). Additionally, the TX-PD group had a significantly lower mortality rate (OR: 0.83; 95 % CI:0.76, 0.90; I² = 88 %; P < 0.0001) and higher re-transplantation rate (OR: 1.56; 95 % CI:1.41, 1.73; I² = 0 %; P < 0.00001) compared to the TX-HD group. Cardiovascular disease, infection, and cancer were the leading causes of death.

Conclusion

The TX-TX group had better survival than the TX-HD group. Survival and re-transplantation rates were higher in the TX-PD group than the TX-HD group. However, age and comorbidities may impact survival and re-transplantation rates between the TX-PD and TX-HD groups, which should be explored further.

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肾移植失败后肾脏替代疗法的结果：系统回顾和荟萃分析

背景肾移植失败后，患者通常有三种肾脏替代疗法（KRT）选择：腹膜透析（PD）、血液透析（HD）或肾脏再移植术。本综述旨在探讨肾移植失败后的 KRT 选择，并比较临床结果：本综述纳入了五个数据库中的研究：Medline、PubMed、Embase、Cochrane 和 CINAHL。研究方案已在 PROSPERO [CRD42024514346] 注册。探讨了肾移植失败的原因。比较了肾移植失败后三组患者的存活率和再移植率：开始 PD 的患者（TX-PD 组）、开始 HD 的患者（TX-HD 组）和无桥接透析的再移植患者（TX-TX 组）。研究还探讨了死亡原因。采用 CASP 检查表评估了纳入研究的质量，并采用 GRADE 方法评估了荟萃分析。慢性损伤被认为是肾移植失败的主要原因。TX-TX组的死亡率低于TX-HD组和TX-PD组，但这一差异仅在与TX-HD组比较时才具有统计学意义（OR：2.57；95 % CI：1.58，4.17；I2 = 79 %；P = 0.0001）。此外，与 TX-HD 组相比，TX-PD 组的死亡率明显较低（OR：0.83；95 % CI：0.76，0.90；I2 = 88 %；P = 0.0001），再移植率较高（OR：1.56；95 % CI：1.41，1.73；I2 = 0 %；P = 0.00001）。心血管疾病、感染和癌症是死亡的主要原因。TX-PD组的存活率和再移植率均高于TX-HD组。然而，年龄和合并症可能会影响TX-PD组和TX-HD组之间的存活率和再移植率，这一点有待进一步探讨。

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来源期刊

Transplantation Reviews IMMUNOLOGY-TRANSPLANTATION

CiteScore

7.50

自引率

2.50%

发文量

审稿时长

29 days

期刊介绍： Transplantation Reviews contains state-of-the-art review articles on both clinical and experimental transplantation. The journal features invited articles by authorities in immunology, transplantation medicine and surgery.