A meta-analysis of graft survival, patient survival and delayed graft function in first-time and repeat kidney transplants.
Kanbay, M., et al.Nephrol Dial Transplant. 2025 Sep 29;40(10):1906-1918.
Aims
The aim of this study was to compare clinical outcomes of kidney transplantation across patients with primary, second, third and fourth transplants, focusing particularly on survival (patient and graft) and the incidence of delayed graft function.
Interventions
Literature search was conducted on MEDLINE (Ovid), Scopus, PubMed, Web of Science and the Cochrane Library. Study selection and data extraction were performed in duplicate. Risk of bias was assessed using the Cochrane Risk of Bias tool for randomised controlled trials and the Newcastle-Ottawa Scale for cohort studies.
Participants
16 studies were included in the review.
Outcomes
The main outcomes of interest were patient survival, graft survival and the incidence of delayed graft function.
Follow-up
N/A
CET Conclusions
This is a large and well-conducted systematic review with meta-analysis; a broad search was conducted across multiple databases and study selection/data extraction was performed in duplicate. 16 studies were included, some of which had several thousand patient results. The study found that graft survival for first transplants is superior to 2nd, 3rd or 4th renal transplants, however this is a well-established outcome given the size and profile of many of the included papers. One additional criticism would be the use of Odds Ratios for survival outcomes, which can over or underestimate survival benefit depending on length of follow up; there was no attempt to calculate or estimate a hazard ratio via the relative log survival method.
Trial registration
PROSPERO - CRD42025595131