Impact of pre-transplant dialysis modality on kidney transplant outcomes: a systematic review and meta-analysis

Y.-F. Hou, X.-X. Wang, H.-J. Yang, S. Zhong

Department of Organ Transplantation, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, China; Clinical Immunology Translational Medicine Key Laboratory of Sichuan Province; Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China. Zhongshan2112@163.com

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• Nephrology
• Surgery

OBJECTIVE: For end-stage renal disease (ESRD), patients receiving kidney transplantation, peritoneal dialysis (PD) and hemodialysis (HD) are both appropriate modes of pre-transplant dialysis. The aim of this review is to assess the impact of pre-transplant PD compared to HD on kidney transplant outcomes in ESRD patients.

MATERIALS AND METHODS: A comprehensive search in digital databases, like PubMed, SCOPUS and EMBASE and a manual search were conducted to identify cohort studies comparing the kidney transplant outcomes of both pre-transplant dialysis modalities. The data were subjected to both qualitative and quantitative analysis. A meta-analysis was carried out to calculate the effect estimate for patient survival, graft survival and delayed graft function, death-censored graft survival, acute rejection-free graft survival, graft vessel thrombosis, urological complications, surgical complications, any infections, and onset of diabetes after transplantation. The qualities of the included studies were judged by the New-castle Ottawa scale.

RESULTS: The overall patient survival is shown to be better with patients who underwent pre-transplant PD compared to HD with OR 1.34 95% CI [1.11, 1.61], p = 0.002. Delayed graft function was found to be highly associated with HD compared to PD with OR 0.60 [0.52, 0.70], p<0.0001 with moderate heterogeneity (i2 = 48%). However, no difference was observed in terms of graft survival, complications, infections, and new onset of diabetes mellitus compared to patients undergoing pre-transplant HD.

CONCLUSIONS: Within the limitations of the review, it can be concluded that ESRD patients undergoing pre-transplant PD were found to have better patient survival and lower incidence of delayed graft function.

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