Transplant Trial Watch

Survival for waitlisted kidney failure patients receiving transplantation versus remaining on waiting list: systematic review and meta-analysis.

Chaudhry, D., et al.

BMJ 2022; 376: e068769.


Aims
This study aimed to evaluate the survival benefit of kidney transplantation compared to remaining on dialysis for waitlisted kidney failure patients.

Interventions
A literature search was performed using Ovid Embase, Web of Science, MEDLINE, Cochrane Collection, and ClinicalTrials.gov. Study selection and data extraction were conducted by two independent reviewers. The risk of bias was assessed using the Newcastle-Ottawa Assessment Scale (NOS) for comparative non-randomised studies.

Participants
48 studies were included in the review.

Outcomes
The main outcome of interest was all cause mortality.

Follow-up
N/A

CET Conclusions
This good quality systematic review and meta-analysis evaluated the survival benefit of kidney transplantation versus remaining on dialysis for waitlisted patients. The review protocol was registered with PROSPERO and a comprehensive literature search was conducted to identify comparative studies. Two independent reviewers screened search results, selected studies, extracted data and assessed the study quality. Overall, the methodological quality of the observational studies was assessed as high quality. Almost all studies (92%) reported a significant long-term (≥1 year) survival benefit from transplantation compared with dialysis. All studies presenting adjusted hazard ratios also reported a survival benefit from kidney transplantation. Meta-analysis of 18 studies showed that kidney transplantation was associated with a 55% lower risk of mortality compared with dialysis. Significant heterogeneity was explored by subgroup analyses, sensitivity analyses and meta-regression analysis however heterogeneity could not be fully explained. The authors note that despite the overall survival benefit for most patients, there may not be a benefit from kidney transplantation for some subgroups.

Trial registration
PROSPERO - CRD42021247247

Funding source
Non-industry funded