Risk Factors for 1-Year Graft Loss After Kidney Transplantation: Systematic Review and Meta-Analysis.Foroutan, F., et al.
Clinical Journal of the American Society of Nephrology 2019; 14(11): 1642-1650.
This study aimed to investigate risk factors that appear to influence kidney graft survival at 1 year following transplantation.
Bibliographic databases including the Cochrane central register for controlled trials, MEDLINE, EMBASE and the Cochrane database for systematic reviews were searched. The Quality in Prognostic Studies instrument was used to assess the risk of bias of individual studies.
35 studies were included in the review.
The outcomes of interest were factors associated with 1-year graft loss including donor factors, transplant process factors, recipient factors and post-transplant complications.
This systematic review looks at studies reporting risk factors (donor, transplant and recipient) for 1-year graft loss following kidney transplantation. The authors included 35 studies, concluding that donor age, ECD, deceased donors, number of HLA mismatches, recipient age and DGF all increase risk of 1-year graft loss. The methodology appears quite robust, and the authors only included studies reporting adjusted multivariate analyses of risk factors including at least donor age. The findings are clearly limited by the quality and assumptions made in the underlying studies – for example assuming a linear relationship between variables and outcomes may miss non-linear effects. Each analysis has only a small number of studies included, and the authors opted not to include measures of heterogeneity due to questions about the validity of I-squared values in data of this nature. However, as they have not presented the forest plots for individual studies, there is no way for the reader to assess for heterogeneity visually.