Efficacy of pre-emptive kidney transplantation for adults with end-stage kidney disease: a systematic review and meta-analysis
AbstractBackground 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 P...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2023-12-01
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| Series: | Renal Failure |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/0886022X.2023.2169618 |
| _version_ | 1797658517359820800 |
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| author | Tatsuhiko Azegami Noriyuki Kounoue Tadashi Sofue Masahiko Yazawa Makoto Tsujita Kosuke Masutani Yuki Kataoka Hideyo Oguchi |
| author_facet | Tatsuhiko Azegami Noriyuki Kounoue Tadashi Sofue Masahiko Yazawa Makoto Tsujita Kosuke Masutani Yuki Kataoka Hideyo Oguchi |
| author_sort | Tatsuhiko Azegami |
| collection | DOAJ |
| description | AbstractBackground 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.Methods 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.Results 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.Conclusions 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. |
| first_indexed | 2024-03-11T18:00:08Z |
| format | Article |
| id | doaj.art-83828129558344d69d594907c72a345b |
| institution | Directory Open Access Journal |
| issn | 0886-022X 1525-6049 |
| language | English |
| last_indexed | 2024-03-11T18:00:08Z |
| publishDate | 2023-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Renal Failure |
| spelling | doaj.art-83828129558344d69d594907c72a345b2023-10-17T09:23:23ZengTaylor & Francis GroupRenal Failure0886-022X1525-60492023-12-0145110.1080/0886022X.2023.2169618Efficacy of pre-emptive kidney transplantation for adults with end-stage kidney disease: a systematic review and meta-analysisTatsuhiko Azegami0Noriyuki Kounoue1Tadashi Sofue2Masahiko Yazawa3Makoto Tsujita4Kosuke Masutani5Yuki Kataoka6Hideyo Oguchi7Keio University Health Center, Yokohama, JapanDepartment of Nephrology, Toho University Faculty of Medicine, Tokyo, JapanDepartment of Cardiovascular and Cerebrovascular Medicine, Kagawa University, Takamatsu, JapanDepartment of Nephrology and Hypertension, St Marianna University School of Medicine, Kawasaki, JapanDepartment of Nephrology, Masuko Memorial Hospital, Nagoya, JapanDepartment of Internal Medicine, Faculty of Medicine, Division of Nephrology and Rheumatology, Fukuoka University, Fukuoka, JapanDepartment of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Kyoto, JapanDepartment of Nephrology, Toho University Faculty of Medicine, Tokyo, JapanAbstractBackground 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.Methods 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.Results 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.Conclusions 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.https://www.tandfonline.com/doi/10.1080/0886022X.2023.2169618Transplantationmeta-analysissystematic reviewpre-emptive kidney transplantationmortalitygraft failure |
| spellingShingle | Tatsuhiko Azegami Noriyuki Kounoue Tadashi Sofue Masahiko Yazawa Makoto Tsujita Kosuke Masutani Yuki Kataoka Hideyo Oguchi Efficacy of pre-emptive kidney transplantation for adults with end-stage kidney disease: a systematic review and meta-analysis Renal Failure Transplantation meta-analysis systematic review pre-emptive kidney transplantation mortality graft failure |
| title | Efficacy of pre-emptive kidney transplantation for adults with end-stage kidney disease: a systematic review and meta-analysis |
| title_full | Efficacy of pre-emptive kidney transplantation for adults with end-stage kidney disease: a systematic review and meta-analysis |
| title_fullStr | Efficacy of pre-emptive kidney transplantation for adults with end-stage kidney disease: a systematic review and meta-analysis |
| title_full_unstemmed | Efficacy of pre-emptive kidney transplantation for adults with end-stage kidney disease: a systematic review and meta-analysis |
| title_short | Efficacy of pre-emptive kidney transplantation for adults with end-stage kidney disease: a systematic review and meta-analysis |
| title_sort | efficacy of pre emptive kidney transplantation for adults with end stage kidney disease a systematic review and meta analysis |
| topic | Transplantation meta-analysis systematic review pre-emptive kidney transplantation mortality graft failure |
| url | https://www.tandfonline.com/doi/10.1080/0886022X.2023.2169618 |
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