Allograft Nephrectomy versus No-Allograft Nephrectomy for Renal Transplantation: A Meta –Analysis

Clinical Transplantation Allograft Nephrectomy versus No-Allograft Nephrectomy for Renal Transplantation: A Meta –Analysis

Abstract

Objective

To assess the safety and efficacy of allograft nephrectomy vs no-allograft nephrectomy for renal re-transplantation.

Methods: Medline (PubMed), Embase, Ovid, Cochrane, and the Chinese Biomedical Literature databases were searched to identify clinically comparable trials which compared allograft nephrectomy(AN) and no-allograft nephrectomy(no-AN) with renal re-transplantation. RevMan 5.1 software and Stat Manager V4.1 software were used for the meta-analysis.

Results

Eight trials were included involving 1008 patients. Of these, 508 (50.4%) patients underwent AN and 500 (49.6%) had not undergone AN before re-transplantation. The pooled results revealed that the AN group had a longer time interval between graft loss and re-transplantation of 14.40 months (weighted mean difference (WMD) = 11.23; 95% confidence interval (CI): 2.47 to 19.99; P = 0.01). The AN group also had an higher rate of positive PRA (PRA>10%) before re-transplantation (OR: odds ratio =1.62, 95%CI=1.17-2.23, P=0.003). A comparison of serum creatinine (mg/dL) at one year after re-transplantation between the groups showed no significant differences (WMD: −0.25; 95%CI: −0.52–0.03; P = 0.08). There were neither significant differences in one-year graft survival rates (OR: 0.74; 95% CI: 0.31–1.72; P = 0.48) nor one-year patient survival rates (OR: 1.60; 95%CI: 0.57–4.46; P = 0.37) between the groups. Insignificant differences were noted for the rates of acute rejection (OR: 1.30; 95%CI: 0.89 to 1.91; P = 0.17) and postoperative complications (OR: 1.51; 95%CI: 0.24–9.43; P = 0.66) for the groups.

Conclusion

Through our meta-analysis, allograft nephrectomy before re-transplantation seemed well tolerated but conferred no significant benefit. The risk benefit ratio of transplant nephrectomy with re-transplantation must be evaluated in each individual patient.

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http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fctr.12654

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Alberto Reino Buelvas 

Médico Internista Nefrólogo