Impact of renal allograft nephrectomy on graft and patient survival following retransplantation: a systematic review and meta-analysis.Lin J, Wang R, et al.
Nephrology Dialysis Transplantation 2018 [record in progress]
To conduct a systematic review and meta-analysis to determine the effect of allograft nephrectomy (AN) and no allograft nephrectomy (No AN) on renal re-transplantation.
The databases Medline, Embase and the Cochrane Library were searched from January 1990 to June 2017 for randomized controlled trials and nonrandomized studies including renal transplant recipients with AN or No-AN. Two independent reviewers screened titles and abstracts, and reviewed full articles to assess eligibility for inclusion. The Newcastle Ottawa scale was independently applied by two authors to assess the quality of analysis.
13 articles were included in the analysis, which comprised 1,802 patients in total (919 who underwent AN and 883 who had not undergone AN).
Primary outcomes measured included graft survival, patient survival, acute rejection, delayed graft dysfunction, positive panel reactive antibody rate and serum creatinine level at 1 year after re-transplantation. Secondary outcomes measured were cold ischemia time and time of hemodialysis before recent transplantation.
The systematic review evaluated the literature regarding the impact of primary allograft nephrectomy versus no allograft nephrectomy on outcomes after kidney retransplantation. A comprehensive search strategy was developed to identify relevant studies with at least 12 month follow up from 1990. Two independent reviewers screened the titles and abstracts, and full text articles for eligibility. Data were extracted by one reviewer which was verified by a second reviewer. The Newcastle Ottawa scale was used to assess the methodological quality of studies and funnel plots were used to assess publication bias. The authors reported that 20 non-random, comparative studies were described in 13 articles, although it seems that the authors incorrectly considered multiple comparisons within one study as separate studies. Meta-analyses were performed for most clinical outcomes but these analyses included duplicate data which may have biased the pooled estimate. Analyses showed that the no-allograft nephrectomy group had a higher 3- and 5-year graft survival rate. The 5-year patient survival rate was higher in the allograft nephrectomy group as was the rate of acute rejection and delayed graft function.
Quality assessment not appropriate