Does pre-emptive transplantation versus post start of dialysis transplantation with a kidney from a living donor improve outcomes after transplantation? A systematic literature review and position statement by the Descartes Working Group and ERBP.
Abramowicz D, Hazzan M, et al.Nephrology Dialysis Transplantation 2016; 31(5): 691-697.
Aims
To provide guidance on pre-emptive kidney transplantation from living donors.
Interventions
A systematic review of the literature was conducted which included observational data, mainly coming from single centre or regional registries, performed after 1990 providing data on aspects of pre-emptive living donation. The databases Medline and Embase were searched on 16 May 2013.
Participants
29 retrospective observational cohort studies (26 published articles and 3 abstracts) were incuded.
Outcomes
The primary outcomes measured were patient survival, graft survival and acute rejection rate.
Follow-up
Not described
CET Conclusions
This guideline from the Descartes Working Group incorporates a systematic review comparing the results of pre-emptive live-donor renal transplantation to those of live-donor transplantation after a period on dialysis. The authors identified 29 papers meeting their inclusion criteria, all of which reported retrospective observational cohort studies. Due to the nature of the evidence, they performed a narrative analysis of the data and found that around half of studies demonstrated improvements in patient and graft survival or reductions in the risk of acute rejection. There was no evidence to suggest differences in outcome relating to pre-transplant GFR. On the basis of the identified data, the authors recommend pre-emptive transplantation where possible, with the timing designed to avoid dialysis as close as possible to the need to start. The guidance provided is obviously limited by the high risk of bias in the included observational studies – the authors recognise that the population characteristics of those receiving a pre-emptive transplant are likely very different to those receiving a transplant whilst on dialysis. In general, the article is well written, the methodology sound, and the limitations are well described. The only aspect perhaps missing is a table to show the numbers and characteristics of patients included in each study.
Quality notes
Quality Assessment not appropriate
Trial registration
None