Predictors of Graft Loss Following Kidney Transplantation: Systematic Review and Meta-Analysis
CCCF ePoster library. Foroutan F. Nov 9, 2018; 233409; 90
Mr. Farid Foroutan
Mr. Farid Foroutan
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Selection of recipients and donors for kidney transplantation is informed by factors that influence the longevity of the graft.  Previous literature identifying predictors and risk scores for graft loss are developed through either single center studies or registries.  Investigators have not thus far conducted a systematic review of these studies.


Our systematic review and meta-analysis aims to identify all predictors and provide best estimates of their association with 1-year death censored graft loss in adult primary kidney transplant recipients. 


We systematically searched MEDLINE, EMBASE, Cochrane database of systematic reviews, Cochrane central registries, and PubMed supplemental for eligible primary studies. We meta-analyzed the independent association (identified with multivariable regression models) between any risk factor (related to donor, recipient, and the transplant operation), and 1-year death censored graft loss. Our review utilized Grading of Recommendations, Assessment, Development, and Evaluation for assessing the quality of the evidence. We pooled effect estimates using the random effects or fixed effects framework, where appropriate. Studies defined extended criteria donors as >60 years of age or age 50 to 59 years with two of three associated risk factors—history of cerebrovascular accident, hypertension, or serum creatinine greater than 1.5 mg/dL and delayed graft function as the need for dialysis within the first week post-transplant. 


High quality evidence identified older recipient age (HR 1.17 per 10-year increase, 95% CI 1.09 to 1.25), older donor age (HR 1.11 per 10-year increase, 95% CI 1.04 to 1.18), extended criteria donors (HR 1.35, 95% CI 1.28 to 1.42), living donor (HR 0.65, 95% CI 0.55 to 0.76), increasing number of human leukocyte antigen (HLA) mismatches (HR 1.08 per 1 mismatch increase, 95% CI 1.07 to 1.09), and delayed graft function (HR 1.89, 95% CI 1.46 to 2.47) as predictors for 1-year graft loss (Table 1). High quality evidence also excluded associations of cold ischemic time, recipient race, recipient BMI, and recipient diabetes with 1-year graft loss.


Donor type and quality, delayed graft function, recipient age, donor age, and HLA mismatch all appear to predict 1-year graft survival. The impact of each factor is, however, modest, suggesting the need for a predictive model that would incorporate multiple factors. The results of this study may be useful to inform future guidelines and predictive models.


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