MO978: Survival for Waitlisted Kidney Failure Patients Receiving Transplantation Versus Remaining on the Waiting List: A Systematic Review and Meta-Analysis. (3rd May 2022)

• Record Type: Journal Article
• Authors: Chaudhry, Daoud; Chaudhry, Abdullah; Peracha, Javeria; Sharif, Adnan
• Is Part Of: Nephrology dialysis transplantation. Volume 37(2022)Supplement 3
• Publication Date: 2022-05-03
• Subjects: Nephrology -- Periodicals; Hemodialysis -- Periodicals; Kidneys -- Transplantation -- Periodicals; Hemodialysis; Kidneys -- Transplantation; Nephrology; Periodicals; 616.61
• DOI: 10.1093/ndt/gfac087.036
• Languages: English
• ISSNs: 0931-0509

Abstract

Abstract: BACKGROUND AND AIMS: Kidney transplantation is acknowledged as the treatment modality of choice for eligible kidney failure patients versus dialysis. However, evidence for survival benefits in marginal kidney transplant candidates is limited. We aimed to investigate the survival benefit of transplantation versus dialysis for waitlisted kidney failure patients with a priori stratification. METHOD: 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. Eligibility criteria for selecting studies: All comparative studies that assessed all-cause mortality of transplantation versus dialysis for kidney failure patients waitlisted for transplant surgery were included. Two independent reviewers extracted the data and assessed the risk of bias of included studies. Meta-analysis was performed using the DerSimonian-Laird random effects model, with heterogeneity investigated by sub-group analyses, sensitivity analyses and meta-regression. RESULTS: Our search identified 48 observational studies with no randomized controlled trials ( n = 1 245 850 patients). In total, 92% of studies ( n = 44/48) reported a long-term (≥1 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 survival benefit (hazard ratio: 0·45, 95% CI: 0·39–0·54, P < 0·0001), with significant heterogeneity even after sub-group/sensitivity analyses or meta-regression analysis. CONCLUSION: Kidney transplantation remains the superior treatment modality for most kidney failure patients to reduce all-cause mortality, but some subgroups may lack a survival benefit. Given the continued scarcity of donor organs, further evidence is necessitated to better inform decision making for kidney failure patients.