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Meta-Analysis
. 2018 Mar 27:23:207-217.
doi: 10.12659/AOT.907700.

Nephrectomy Versus Embolization of Non-Functioning Renal Graft: A Systematic Review with a Proportional Meta-Analysis

Henrique Mochida Takase  1 , Mariana Moraes Contti  1 , Hong Si Nga  1 , Ariane Moyses Bravin  1 , Mariana Farina Valiatti  1 , Regina Paolucci El-Dib  2 , Luis Gustavo Modelli de Andrade  3
Affiliations
Meta-Analysis

Nephrectomy Versus Embolization of Non-Functioning Renal Graft: A Systematic Review with a Proportional Meta-Analysis

Henrique Mochida Takase et al. Ann Transplant. .

Abstract

There is no standardization on the timing of the best approach to treat a non-functioning renal graft. We reviewed the literature and performed a proportional meta-analysis of case series of transplantectomy and embolization for a non-functioning renal graft. The groups were compared for mortality and morbidity outcomes. A total of 2421 patients were included in this review. Of these, 2232 patients underwent transplantectomy and 189 underwent percutaneous embolization. The mortality rate in the nephrectomy group was 4% [95% confidence interval [CI], 2-7%; I²=87%] as compared with 0.1% [95% CI, 0.1-0.5%; I²=0%] in the embolization group. The rates of common morbidities were 18% [95% CI, 13-26%, I²=79.7%] for nephrectomy compared with 1.2% [95% CI, 0.7-2.1%, I²=26.4%] for embolization. The incidence of post-embolization syndrome was 68%, and 20% of patients needed post-embolization nephrectomy. Percutaneous embolization was associated with lower mortality and morbidity rates but also with a high rate of post-embolization syndrome. However, in most cases this complication had easily manageable symptoms. Embolization is a new and attractive technique that can be considered in treating non-functioning renal grafts.

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Conflict of interest statement

Conflict of Interest

None.

Figures

Figure 1
Figure 1
Flowchart of the bibliographic search and selection of the articles identified and evaluated during the review process.
Figure 2
Figure 2
Proportional meta-analysis forest plot of case series regarding mortality after a non-functioning renal graft. (A) Mortality in the transplantectomy group (scale ×100); (B) Mortality in the embolization group (scale ×10).
Figure 3
Figure 3
Combined mortality rate with 95% confidence interval of studies of non-functioning renal grafts in the transplantectomy and embolization groups. There are significant differences between groups due to no overlap of the 95% confidence intervals.
Figure 4
Figure 4
Proportional meta-analysis forest plot of case series regarding morbidities after a non-functioning renal graft. (A) Morbidity in the transplantectomy group (scale ×100); (B) Morbidity in the embolization group (scale ×10).
Figure 5
Figure 5
Combined morbidity rate with 95% confidence interval of studies of a non-functioning renal graft in the transplantectomy and embolization groups. There are significant differences between groups due to no overlap of the 95% confidence intervals.
See this image and copyright information in PMC

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