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Meta-Analysis
. 2019 Nov 7;14(11):1642-1650.
doi: 10.2215/CJN.05560519. Epub 2019 Sep 20.

Risk Factors for 1-Year Graft Loss After Kidney Transplantation: Systematic Review and Meta-Analysis

Farid Foroutan  1   2 , Erik Loewen Friesen  3 , Kathryn Elizabeth Clark  1 , Shahrzad Motaghi  2 , Roman Zyla  3 , Yung Lee  2 , Rakhshan Kamran  2 , Emir Ali  2 , Mitch De Snoo  4 , Ani Orchanian-Cheff  5 , Christine Ribic  4 , Darin J Treleaven  4 , Gordon Guyatt  2 , Maureen O Meade  2
Affiliations
Meta-Analysis

Risk Factors for 1-Year Graft Loss After Kidney Transplantation: Systematic Review and Meta-Analysis

Farid Foroutan et al. Clin J Am Soc Nephrol. .

Abstract

Background and objectives: With expansion of the pool of kidney grafts, through the use of higher-risk donors, and increased attention to donor management strategies, the 1-year graft survival rate is subject to change. It is, therefore, useful to elucidate 1-year graft survival rates by dissecting the characteristics of the low-risk and high-risk kidney transplant cases. The objective of our study was to evaluate factors purported to influence the risk of 1-year graft loss in kidney transplant recipients.

Design, setting, participants, & measurements: We searched bibliographic databases from 2000 to 2017 and included observational studies that measured the association between donor, recipient, the transplant operation, or early postoperative complications, and 1-year death-censored graft loss.

Results: We identified 35 eligible primary studies, with 20 risk factors amenable to meta-analysis. Six factors were associated with graft loss, with moderate to high degree of certainty: donor age (hazard ratio [HR], 1.11 per 10-year increase; 95% confidence interval [95% CI], 1.04 to 1.18), extended criteria donors (HR, 1.35; 95% CI, 1.28 to 1.42), deceased donors (HR, 1.54; 95% CI, 1.32 to 1.82), number of HLA mismatches (HR, 1.08 per one mismatch increase; 95% CI, 1.07 to 1.09), recipient age (HR, 1.17 per 10-year increase; 95% CI, 1.09 to 1.25), and delayed graft function (HR, 1.89; 95% CI, 1.46 to 2.47) as risk factors for 1-year graft loss. Pooled analyses also excluded, with a high degree of certainty, any associations of cold ischemia time, recipient race, pretransplant body mass index, diabetes, and hypertension with 1-year graft loss.

Conclusions: Recipient age, donor age, standard versus extended criteria donor, living versus deceased donor, HLA mismatch, and delayed graft function all predicted 1-year graft survival. The effect of each risk factor is small.

Keywords: Epidemiology and outcomes; HLA antigens; Transplantation; attention; bibliographic databases; body mass index; chronic allograft failure; cold ischemia; delayed graft function; diabetes mellitus; graft survival; humans; hypertension; kidney transplantation; living donors; risk factors; transplant recipients.

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Figures

None
Graphical abstract
Figure 1.
Figure 1.
Total of 35 studies included in systematic review and meta-analysis.
Figure 2.
Figure 2.
Eleven of 19 risk factors significantly associated with 1-year graft loss.
See this image and copyright information in PMC

References

    1. Tonelli M, Wiebe N, Knoll G, Bello A, Browne S, Jadhav D, Klarenbach S, Gill J: Systematic review: Kidney transplantation compared with dialysis in clinically relevant outcomes. Am J Transplant 11: 2093–2109, 2011 - PubMed
    1. Matas AJ, Smith JM, Skeans MA, Thompson B, Gustafson SK, Stewart DE, Cherikh WS, Wainright JL, Boyle G, Snyder JJ, Israni AK, Kasiske BL: OPTN/SRTR 2013 annual data report: Kidney. Am J Transplant 15[Suppl 2]: 1–34, 2015 - PubMed
    1. Hart A, Smith JM, Skeans MA, Gustafson SK, Wilk AR, Robinson A, Wainright JL, Haynes CR, Snyder JJ, Kasiske BL, Israni AK: OPTN/SRTR 2016 annual data report: Kidney. Am J Transplant 18[Suppl 1]: 18–113, 2018 - PMC - PubMed
    1. Kabore R, Haller MC, Harambat J, Heinze G, Leffondré K: Risk prediction models for graft failure in kidney transplantation: A systematic review. Nephrol Dial Transplant 32[Suppl 2]: ii68–ii76, 2017 - PubMed
    1. Alba AC, Agoritsas T, Walsh M, Hanna S, Iorio A, Devereaux PJ, McGinn T, Guyatt G: Discrimination and calibration of clinical prediction models: Users’ guides to the medical literature. JAMA 318: 1377–1384, 2017 - PubMed