While kidney transplantation is the best treatment option for most patients with renal failure when it comes to patient survival, it does not appear to be the case for all patients. Given the continuing shortage of donor organs, it is important to further investigate this in order to improve decision-making about transplantation.
This is the conclusion of researchers from the UK based on a systematic review. They included all studies comparing mortality between patients who had undergone a kidney transplant and patients on dialysis on the waiting list for a kidney transplant, which were available on 1 March 2021 in online literature databases (MEDLINE, Ovid Embase, Web of Science, Cochrane Collection, ClinicalTrials .gov).
They found 48 observational studies that met the criteria and involved a total of 1,245,850 patients. In 44 of these studies (92%) a better long-term survival – after at least 1 year – was found after transplantation than on dialysis. But in 11 of the studies, there were subgroups of patients who did not benefit from this benefit, for example, patients with glomerulonephritis, hypertension, or a hereditary condition such as primary kidney disease or patients with a body mass index ≥ 41. In the remaining four studies (8 %) no difference was found between the two groups; no study found a lower mortality risk for the dialysis group.
Eighteen studies could be analyzed together in a meta-analysis with a random-effects model. Here too, kidney transplantation was found to be associated with a better patient survival than dialysis (HR 0.45; 95% CI 0.39-0.54; p < 0.001). There was, however, significant heterogeneity between the individual studies.
Bron:
Chaudhry D, Chaudhry A, Peracha J, et al. Survival for waitlisted kidney failure patients receiving transplantation versus remaining on waiting list: systematic review and meta-analysis. BMJ 2022;376:e068769.