Comparison of survival outcomes between Expanded Criteria Donor and Standard Criteria Donor kidney transplant recipients: a systematic review and meta-analysis.
Querard A, Foucher Y, et al.Transplant International 2016; 29(4): 403-415.
Aims
To accurately quantify the differences between Expanded Criteria Donor (ECD) and Standard Criteria Donor (SCD) transplants, and to estimate the three corresponding survival curves for both ECD and SCD kidney recipients.
Interventions
A systematic review and meta-analysis was conducted, whereby eligible studied included those published in any language that reported results relating to at least one survival outcome, using survival regression models comparing ECD kidney recipients and SCD kidney recipients after adjustment on confounding factors and/or description of long-term outcomes for ECD kidney transplant recipients. The databases Medline, Embase, Cochrane Database of Systematic Reviews and Clinical Trials, Web of Science, Google Scholar, Open Grey, Base, and the website of the French Society of Nephrology were searched
Participants
32 publications were included in the analysis.
Outcomes
The primary measured outcomes were patient-graft survival, patient survival and death-censored graft survival. The secondary measured outcome was pooled survival curves.
Follow-up
5 years
CET Conclusions
This systematic review and meta-analysis includes studies reporting survival outcomes for extended- and standard- criteria donor kidney transplants. The authors report that ECD recipients have a poorer prognosis than SCD recipients, with worse graft and patient survival. They also report data suggesting that the differences between ECD and SCD outcomes are smaller in European studies compared to US studies. The systematic review methodology used is robust, although no formal assessment of risk of bias is reported. Unfortunately, the only studies available reporting survival analysis adjusted for confounders all came from the US, with overlapping time periods. As one of the reported studies was an analysis of a large dataset from the SRTR registry, it is likely that this included data from the patients from the other, smaller studies. The results presented are therefore very heavily biased towards the SRTR data, providing little additional information to this individual study. The authors do also perform analysis of unadjusted survival estimates from other international publications, which unsurprisingly shows significant heterogeneity with likely important differences between SCD and ECD recipient populations. The observation that the differences between SCD and ECD outcomes are smaller in European than US recipients is not supported by the data, with significant overlap between the very wide 95% confidence intervals reported.
Quality notes
Quality assessment not appropriate
Trial registration
None