Allograft nephrectomy vs. no‐allograft nephrectomy for renal transplantation: a meta‐analysis

AbstractObjectiveTo assess the safety and efficacy of allograft nephrectomy vs. no‐allograft nephrectomy for renal re‐transplantation.MethodsMedline (PubMed), Embase, Ovid, Cochrane, and the Chinese Biomedical Literature databases were searched to identify clinically comparable trials that 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.ResultsEight trials were included involving 1008 patients. Of these, 508 (50.4%) patients underwentANand 500 (49.6%) had not undergoneANbefore re‐transplantation. The pooled results revealed that theANgroup 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): 2.47–19.99; p = 0.01). TheANgroup also had an higher rate of positivePRA(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 yr after re‐transplantation between the groups showed no significant differences (WMD: −0.25; 95%CI: −0.52 to 0.03; p = 0.08). There were neither significant differences in one‐yr graft survival rates (OR: 0.74; 95%CI: 0.31–1.72; p = 0.48) nor one‐yr 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: 0.89–1.91; p = 0.17) and post‐operative complications (OR: 1.51; 95%CI: 0.24–9.43; p = 0.66) for the groups.ConclusionThrough 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.