Transplant Trial Watch

Postoperative outcomes of kidney transplant recipients undergoing non-transplant-related elective surgery: a systematic review and meta-analysis.

Palamuthusingam, D., et al.

BMC Nephrology 2020; 21(1): 365.

The aim of this study was to provide an estimation of the odds of fatal and non-fatal postoperative outcomes in recipients of renal transplant after elective surgery in comparison to non-transplanted patients.

Electronic databases including MEDLINE and Embase were searched from inception to January 2020. Studies were assessed for eligibility by two independent researchers. The Newcastle Ottawa Scale was used to assess the risk of bias.

14 studies were included in the review.

The primary outcome was mortality (all-causes). The secondary outcomes were stroke, myocardial infarction, congestive cardiac failure, surgical site infection, sepsis, pneumonia, thromboembolic events, acute kidney injury (AKI) and return to theatre.


CET Conclusions
This systematic review investigated the risks of non-transplant-related elective surgery (mainly orthopaedic, cardiac and general procedures) in renal transplant recipients. The authors found increased risk of mortality in renal transplant recipients, especially in the setting of diabetes. Risk of AKI and sepsis were also substantially higher, but not the risk of stroke or other infective complications. The methodology used is very good – the study is only hampered by the low-quality observational evidence identified, with small numbers of studies and high degrees of heterogeneity in some analyses. Many of the underlying studies do not adjust for confounding factors leading to some uncertainty in the overall findings. However, there is no doubt that this is an at-risk patient population, who would serve well being managed jointly with experienced transplant physicians at the time of elective surgery.

Trial registration
PROSPERO - CRD42019127267

Funding source
No funding received