Allograft nephrectomy vs. 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 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. 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): 2.47-19.99; 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 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. 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.