Efficacy of pre-emptive kidney transplantation for adults with end-stage kidney disease: a systematic review and meta-analysis

Pre-emptive kidney transplantation (PEKT), i.e., transplantation performed before initiation of maintenance dialysis, is considered an ideal renal replacement therapy because there is no exposure to long-term dialysis therapy. Therefore, we summarized advantages/disadvantages of PEKT to assist in de...

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Veröffentlicht in:Renal failure Jg. 45; H. 1; S. 2169618
Hauptverfasser: Azegami, Tatsuhiko, Kounoue, Noriyuki, Sofue, Tadashi, Yazawa, Masahiko, Tsujita, Makoto, Masutani, Kosuke, Kataoka, Yuki, Oguchi, Hideyo
Format: Journal Article
Sprache:Englisch
Veröffentlicht: England Taylor & Francis 01.12.2023
Taylor & Francis Ltd
Taylor & Francis Group
Schlagworte:
Adult
Biopsy
Cardiovascular diseases
Child
Clinical Study
Cytomegalovirus
Cytomegalovirus Infections
Dialysis
End-stage renal disease
graft failure
Graft rejection
Humans
Kidney diseases
Kidney Failure, Chronic - therapy
Kidney transplantation
Kidney Transplantation - methods
Kidney transplants
Meta-analysis
Mortality
Patients
Pediatrics
pre-emptive kidney transplantation
Quality of Life
Renal Dialysis
Systematic review
Transplantation
Urinary tract
meta-analysis
mortality
Transplantation
pre-emptive kidney transplantation
graft failure
systematic review
ISSN:0886-022X, 1525-6049, 1525-6049
Online-Zugang:Volltext
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Zusammenfassung:Pre-emptive kidney transplantation (PEKT), i.e., transplantation performed before initiation of maintenance dialysis, is considered an ideal renal replacement therapy because there is no exposure to long-term dialysis therapy. Therefore, we summarized advantages/disadvantages of PEKT to assist in deciding whether kidney transplantation should be performed pre-emptively. This study was registered with PROSPERO, CRD42021269163. Observational studies comparing clinical outcomes between PEKT and non-PEKT were included; those involving only pediatric recipients or simultaneous multi-organ transplantations were excluded. The PubMed/MEDLINE, Cochrane Library, and Ichushi-Web databases were searched on 1 August 2021. Studies were pooled using the generic inverse-variance method with random effects model, and risk of bias was assessed using ROBINS-I. Seventy-six studies were included in the systematic review (sample size, 23-121,853; enrollment year, 1968-2019). PEKT patients had lower all-cause mortality (adjusted HR: 0.78 [95% CI 0.66-0.92]), and lower death-censored graft failure (0.81 [0.67-0.98]). Unadjusted RRs for the following outcomes were comparable between the two patient groups: cardiovascular disease, 0.90 (0.58-1.40); biopsy-proven acute rejection, 0.75 (0.55-1.03); cytomegalovirus infection, 1.04 (0.85-1.29); and urinary tract infection, 0.89 (0.61-1.29). Mean differences in post-transplant QOL score were comparable in both groups. The certainty of evidence for mortality and graft failure was moderate and that for other outcomes was very low following the GRADE classification. The present meta-analysis shows the potential benefits of PEKT, especially regarding patient and graft survival, and therefore PEKT is recommended for adults with end-stage kidney disease.
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Both authors contributed equally to this work.
Supplemental data for this article can be accessed online at https://doi.org/10.1080/0886022X.2023.2169618
ISSN:0886-022X
1525-6049
1525-6049
DOI:10.1080/0886022X.2023.2169618