Postoperative outcomes of kidney transplant recipients undergoing non-transplant-related elective surgery: a systematic review and meta-analysis

• Published in: BMC nephrology Vol. 21; no. 1; pp. 365 - 13
• Main Authors: Palamuthusingam, Dharmenaan, Kunarajah, Kuhan, Pascoe, Elaine M., Johnson, David W., Hawley, Camel M., Fahim, Magid
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 25.08.2020; BioMed Central; BMC
• Subjects: Bias; Cardiovascular disease; Care and treatment; Complications; Diabetes; Diabetes mellitus; Elective surgery; Gynecology; Heart surgery; Kidney diseases; Kidney transplant; Kidney transplantation; Kidney transplants; Kidneys; Meta-analysis; Mortality; Myocardial infarction; Nephrology; Organ transplant recipients; Patient outcomes; Patients; Perioperative outcomes; Population; Postoperative mortality; Postoperative period; Risk assessment; Sensitivity analysis; Statistical analysis; Stroke; Surgery; Surgery, Elective; Surgical outcomes; Surgical risk; Systematic review; Transplantation; Australia; Infection; Myocardial infarction; Perioperative outcomes; Postoperative mortality; Stroke; Kidney transplant; Surgical risk
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/s12882-020-01978-4

Reliable estimates of the absolute and relative risks of postoperative complications in kidney transplant recipients undergoing elective surgery are needed to inform clinical practice. This systematic review and meta-analysis aimed to estimate the odds of both fatal and non-fatal postoperative outcomes in kidney transplant recipients following elective surgery compared to non-transplanted patients. Systematic searches were performed through Embase and MEDLINE databases to identify relevant studies from inception to January 2020. Risk of bias was assessed by the Newcastle Ottawa Scale and quality of evidence was summarised in accordance with GRADE methodology (grading of recommendations, assessment, development and evaluation). Random effects meta-analysis was performed to derive summary risk estimates of outcomes. Meta-regression and sensitivity analyses were performed to explore heterogeneity. Fourteen studies involving 14,427 kidney transplant patients were eligible for inclusion. Kidney transplant recipients had increased odds of postoperative mortality; cardiac surgery (OR 2.2, 95%CI 1.9-2.5), general surgery (OR 2.2, 95% CI 1.3-4.0) compared to non-transplanted patients. The magnitude of the mortality odds was increased in the presence of diabetes mellitus. Acute kidney injury was the most frequently reported non-fatal complication whereby kidney transplant recipients had increased odds compared to their non-transplanted counterparts. The odds for acute kidney injury was highest following orthopaedic surgery (OR 15.3, 95% CI 3.9-59.4). However, there was no difference in the odds of stroke and pneumonia. Kidney transplant recipients are at increased odds for postoperative mortality and acute kidney injury following elective surgery. This review also highlights the urgent need for further studies to better inform perioperative risk assessment to assist in planning perioperative care.