Multiple Renal Arteries in Kidney Transplantation: A Systematic Review and Meta-Analysis.
Zorgdrager M, Krikke C, et al.Annals of Transplantation 2016; 21: 469-478.
Aims
To conduct a systematic review to determine the outcomes of multiple renal arteries (MRA) grafts compared to single renal artery (SRA) grafts in renal transplantation.
Interventions
A systematic literature search was conducted using PubMed, EMBASE, and the Cochrane Library. Larger studies published since 1985 up to July 2014 that reported more than 50 MRA grafts were included.
Participants
23 studies, comprising a total of 18,289 patients were included in the meta-analysis.
Outcomes
The primary outcomes measured was graft survival at 1 year and 5 years. Secondary outcomes measured were patient survival, complication rates, creatinine levels, and warm ischemia time.
Follow-up
5 years
CET Conclusions
This systematic review examined published studies reporting outcomes of renal transplants with more than one renal artery. Across the 20 identified studies, grafts with multiple arteries demonstrated higher risk of complications and delayed graft function, and had significantly lower 1-year graft survival. However, long-term graft and patient survival were equivalent. Whilst these results are interesting, there are a few potential sources of bias present that are worth mentioning. Firstly, the authors exclude 41 small (<50 patient) and 11 non-English studies, which may bias results towards larger and more experienced transplant centres. Overall quality of the included studies was poor, based mainly on retrospective analysis. It is obviously difficult to examine a topic like this prospectively, and so the results do provide some encouragement that long-term outcomes are equivalent.
Quality notes
Quality assessment not appropriate
Trial registration
Prospero ID - CRD42014013136