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Meta-Analysis
. 2022 Mar 1:376:e068769.
doi: 10.1136/bmj-2021-068769.

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

Daoud Chaudhry  1 , Abdullah Chaudhry  1 , Javeria Peracha  2 , Adnan Sharif  2   3
Affiliations
Meta-Analysis

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

Daoud Chaudhry et al. BMJ. .

Abstract

Objectives: To investigate the survival benefit of transplantation versus dialysis for waitlisted kidney failure patients with a priori stratification.

Design: Systematic review and meta-analysis.

Data sources: Online databases MEDLINE, Ovid Embase, Web of Science, Cochrane Collection, and ClinicalTrials.gov were searched between database inception and 1 March 2021.

Inclusion criteria: All comparative studies that assessed all cause mortality for transplantation versus dialysis in patients with kidney failure waitlisted for transplant surgery were included. Two independent reviewers extracted the data and assessed the risk of bias of included studies. Meta-analysis was done using the DerSimonian-Laird random effects model, with heterogeneity investigated by subgroup analyses, sensitivity analyses, and meta-regression.

Results: The search identified 48 observational studies with no randomised controlled trials (n=1 245 850 patients). In total, 92% (n=44/48) of studies reported a long term (at least one year) survival benefit associated with transplantation compared with dialysis. However, 11 of those studies identified stratums in which transplantation offered no statistically significant benefit over remaining on dialysis. In 18 studies suitable for meta-analysis, kidney transplantation showed a survival benefit (hazard ratio 0.45, 95% confidence interval 0.39 to 0.54; P<0.001), with significant heterogeneity even after subgroup/sensitivity analyses or meta-regression analysis.

Conclusion: Kidney transplantation remains the superior treatment modality for most patients with kidney failure to reduce all cause mortality, but some subgroups may lack a survival benefit. Given the continued scarcity of donor organs, further evidence is needed to better inform decision making for patients with kidney failure.

Study registration: PROSPERO CRD42021247247.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: DC had support from the Royal College of Surgeons (England) for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig 1
Fig 1
Study selection for systematic review and meta-analysis. Tx=transplantation; WL=waiting list
Fig 2
Fig 2
Forest plot of hazard ratios (with 95% confidence interval (CIs)) for transplantation versus waitlisted dialysis, stratified by geographical region. lnHR=log hazard ratio; seHR=standard error hazard ratio
Fig 3
Fig 3
Forest plot of hazard ratios (with 95% confidence interval (CIs)) for transplantation versus waitlisted dialysis, stratified by donor type. lnHR=log hazard ratio; seHR=standard error hazard ratio
Fig 4
Fig 4
Forest plot of hazard ratios (with 95% confidence interval (CIs)) for transplantation versus waitlisted dialysis, stratified by population type. lnHR=log hazard ratio; seHR=standard error hazard ratio
Fig 5
Fig 5
GOSH plot (graphical display of heterogeneity) of I2 against summary effect sizes (log hazard ratio) indicating unimodal effect measure but bimodal heterogeneity pattern. Regardless of study selection, heterogeneity remains significant
See this image and copyright information in PMC

Comment in

References

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