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Kabani R, Quinn RR, Palmer S, Lewin AM, Yilmaz S, Tibbles LA, Lorenzetti DL, Strippoli GFM, McLaughlin K, Ravani P. Risk of death following kidney allograft failure: a systematic review and meta-analysis of cohort studies. Nephrol Dial Transplant 2014; 29:1778-86. [PMID: 24895440 DOI: 10.1093/ndt/gfu205] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND People with kidney allograft failure represent an increasing fraction of all those starting dialysis therapy. We sought to summarize prognosis following kidney allograft failure and identify potentially beneficial interventions or modifiable risk factors. METHODS We searched MEDLINE and EMBASE (inception to 1 October 2013) and article reference lists without language restriction and selected cohort studies of all-cause mortality and fatal infection-related and cardiovascular events in people starting dialysis following kidney allograft failure. Two reviewers independently extracted data on study design, participant characteristics, dialysis modality, transplant nephrectomy, immunosuppression strategy, transplant-naive comparators and risk of bias. Discrepancies were resolved with a third reviewer. RESULTS Forty studies comprising 249 716 participants met the inclusion criteria. The first year of dialysis therapy was associated with the highest mortality. By random effects meta-analysis, annual risk of death, from years 1 to 4, was 0.12 [95% confidence interval (95% CI): 0.09-0.15], 0.06 (95% CI: 0.05-0.07), 0.05 (95% CI: 0.04-0.06) and 0.05 (95% CI: 0.04-0.06), respectively. We found high heterogeneity in each meta-analysis, which remained unexplained by prespecified subgroup analyses. We could not find sufficient information to summarize the risk for fatal infection-related and cardiovascular events, or to test the role of transplant nephrectomy or different immunosuppressive strategies. Risk of bias was high, especially participation bias. CONCLUSION Mortality is higher during the first year of dialysis treatment following kidney allograft failure than in subsequent years. Insufficient data are available to assess factors or interventions potentially impacting prognosis following kidney allograft failure. In a culture promoting transplantation, clinical research of different models of care in this growing high-risk population should be a research priority.
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Affiliation(s)
- Rameez Kabani
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Robert R Quinn
- Department of Medicine, University of Calgary, Calgary, AB, Canada Community Health Sciences, Institute of Public Health, University of Calgary, Calgary, AB, Canada Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Suetonia Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Adriane M Lewin
- Community Health Sciences, Institute of Public Health, University of Calgary, Calgary, AB, Canada Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Serdar Yilmaz
- Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Lee A Tibbles
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Diane L Lorenzetti
- Community Health Sciences, Institute of Public Health, University of Calgary, Calgary, AB, Canada Institute of Health Economics, University of Alberta, Edmonton, AB, Canada
| | - Giovanni F M Strippoli
- Cochrane Renal Group, Sydney, Australia School of Public Health, University of Sydney, Sydney, Australia Mario Negri Sud Consortium, Saunta Maria Imbaro, Chieti, Italy Diaverum Medical Scientific Office, Lund, Sweden University of Bari, Bari, Italy
| | - Kevin McLaughlin
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Pietro Ravani
- Department of Medicine, University of Calgary, Calgary, AB, Canada Community Health Sciences, Institute of Public Health, University of Calgary, Calgary, AB, Canada Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
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Coppolino G, Criseo M, Nostro L, Floccari F, Aloisi C, Romeo A, Frisina N, Buemi M. Management of Patients after Renal Graft Loss: An Open Question for Nephrologists. Ren Fail 2009; 28:203-10. [PMID: 16703791 DOI: 10.1080/08860220600580357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Patients undergoing renal graft failure and returning to dialysis are often regarded to like facing for the first time a substitutive treatment, without considering the technical complications, the economical impact, and the psychological implications. This review attempt, to give answers to various questions, concerning the management of vascular access, the immunosuppressive therapy, the transplantectomy, the emotional and neuropsychic aspects, and the quality of life of graft-failed patients.
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