Background
Methods
Literature search strategy
Study selection
Outcome measures
Data extraction and quality assessment
Statistical analysis
Results
Author, year | No. of recipients | Mean age, years | Male, % | Year data collection | Country of origin | Data Source | Type of risk (Adjustments) | Quality score |
---|---|---|---|---|---|---|---|---|
De Fijter, 2001 [20] | 496 | 47.4 | 62.1 | 1983–1997 | Netherlands | Single-center | Recipient and donor age and gender, CIT, PRA, initial immunosuppression, DGF, ARE, type of AR | 8 |
Roodnat, 2003 [21] | 1124 | 44.8 | 58.5 | 1981–2000 | Netherlands | Single-center | Recipient and donor age, donor gender, CIT, donor Cr, transplantation year, donor type, number of previous transplants | 8 |
Tekin, 2015 [22] | 2633 | 47.7 | 40.4 | 2008–2013 | Turkey | Single-center | Recipient and donor age and gender, donor follow-up Cr levels, time on dialysis, original disease, CIT, DGF, ARE, recipient serum Cr-levels, warm ischemia times | 7 |
Mandal, 2003 [23] | 31,909 | NR | 59.0 | 1995–1998 | USA | Registry (USRDS) | Recipient and donor age, recipient gender and race, donor type, CIT, diabetic nephropathy | 8 |
Arias, 2007 [24] | 214 | 47.7 | 64.0 | NR | Spain | Single-center | Recipient and donor age and gender, donor type, ARE, CMV, CIT, PRA, glomerulosclerosis, interstitial fibrosis, tubular atrophy, arteriosclerosis, arteriolar hyalinosis | 8 |
Cho, 2016 [25] | 229 | 63.2 | 63.6 | 1995–2014 | Korea | Single-center | Recipient and donor age, donor type, recipient gender, ABO-incompatible, DGF, CMV, HBV, HCV, time on dialysis prior to transplantation | 8 |
Gomez, 2013 [26] | 487 | 38.0 | 63.2 | 1979–1997 | Spain | Single-center | Recipient and donor age, donor gender, donor type, DGF, CIT, PRA, AR, time on dialysis, immunosuppression | 8 |
Laging, 2012 [28] | 1821 | 47.8 | 62.0 | 1990–2009 | Netherlands | Single-center | Recipient and donor age, maximum PRA, current PRA, transplant year, donor gender, donor type, DGF, immunosuppression | 8 |
Laging, 2014 [35] | 1998 | 48.2 | 62.5 | 1990–2010 | Netherlands | Single-center | Recipient and donor age, donor gender, donor type, PRA, transplant year, immunosuppression | 8 |
Schnuelle, 1999 [30] | 152 | 46.4 | 56.7 | 1989–1998 | Germany | Single-center | Recipient and donor age, recipient gender, time on dialysis, original disease, PRA, dopamine, noradrenaline, head trauma, previous transplant, immunosuppression, Induction (ATG/OKT3) | 8 |
Hariharan, 2002 [32] | 105,742 | NR | NR | 1988–1998 | USA | Registry (OPTN/UNOS) | Recipient and donor age and race, gender, DM, hypertensive nephropathy, pre-TX dialysis and transfusions, previous transplant, most recent PRA, DGF, donor type, 1-year AR, induction therapy, immunosuppression regiment | 7 |
Massie, 2016 [19] | 106,019 | 50.0 | 62.4 | 2005–2013 | USA | Registry (SRTR) | Recipient and donor age, gender and race, PRA, transplant year, private insurance, HCV, eGFR, BMI, cigarette use, SBP, ABO-incompatible, unrelated to recipient, min(donor/recipient weight ratio,0.9) | 8 |
Cho, 2012 [33] | 39,332 | 52.0 | 51.2 | 2000–2008 | USA | Registry (OPTN/UNOS) | Recipient and donor age, gender, race, CAD, CVD, DM, PVD, pulmonary, malignancy, CMV, DGF, rejection treatment | 8 |
Croke, 2010 [27] | 12,662 | NR | NR | 1985–2007 | Australia/ New Zealand | Registry (ANZDATA) | Donor and recipient variables,transplant year,type of initial CNI | 8 |
Connolly, 1996 [31] | 516 | NR | 67.4 | 1989–1993 | UK | Single-center | Recipient and donor age and gender, donor type, DGF, CIT, PRA, ARE, warm ischemia time, | 8 |
Asderakis, 2001 [29] | 788 | 42.1 | 67.8 | 1990–1995 | UK | Single-center | Recipient and donor gender, donor age, DGF, CIT, ARE, immunosuppression | 8 |
Opelz, 2007 [35] | 135,970 | NR | 61.6 | 1985–2004 | Germany | Registry (CTS) | Recipient and donor age, gender, and race, PRA, CIT, transplant year, time on dialysis, original disease, previous transplant, pre-transplant dialysis, recipient geographical origin, immunosuppression | 8 |
Amatya, 2010 [36] | 229 | 40.5 | 59.4 | 1997–2007 | USA | Single-center | Recipient age, gender, and race, BMI, PRA, previous transplant, CIT, WIT | 8 |
Zukowski, 2014 [40] | 232 | 37.7 | 63.8 | 1997–1998 | Poland | Multi-center | Univariate | 6 |
Fellstrom, 2005 [41] | 2102 | 51 | 65.2 | 1996–1997 | Europe | Multi-center | Univariate | 6 |
Summers 2010 [37] | 9134 | 47 | 61.4 | 2000–2007 | UK | Registry (UK transpalnt registry) | Recipient age, donor age, CIT | 6 |
Van 1996 [39] | 1289 | 32.8 | 60.9 | 1966–1994 | Netherlands | Single-center | Recipient and donor age and gender, type of immnnosuppression, presensitisation, DM, and living or post-mortem donor | 8 |
Lynch 2013 [38] | 31,534 | N/A | N/A | 2000–2010 | USA | Registry (SRTR) | Not reported | 8 |
Primary outcomes
HLA per mismatch and overall graft failure
HLA per mismatch | HLA-DR mismatches | |||||||
---|---|---|---|---|---|---|---|---|
Subgroup | No. of recipients (cohorts) | HR (95% CI) |
I
2
|
P
a
| No. of recipients (cohorts) | HR (95% CI) |
I
2
|
P
a
|
Sample size | 0.835 | 0.011 | ||||||
≥10,000 | 281,141 (5) | 1.06 (1.05–1.07) | 49.1 | 145,351 (2) | 1.07 (1.04–1.10) | 0 | ||
< 10,000 | 8614 (7) | 1.06 (1.03–1.09) | 17.3 | 4652 (5) | 1.27 (1.12–1.43) | 48.4 | ||
Nature of data | 0.133 | 0.076 | ||||||
Univariable-unadjusted | 1440 (4) | 1.14 (1.04–1.26) | 24.8 | 2598 (2) | 1.39 (1.05–1.83) | 70.0 | ||
Multivariable-adjusted | 286,755 (12) | 1.06 (1.05–1.07) | 27.4 | 150,003 (7) | 1.08 (1.05–1.11) | 58.3 | ||
Data source | 0.683 | 0.011 | ||||||
Registry/Multi-center | 286,283 (6) | 1.06 (1.05–1.07) | 38.9 | 145,351 (2) | 1.07 (1.04–1.10) | 0 | ||
Single-center | 3472 (6) | 1.07 (1.02–1.12) | 26.6 | 4652 (5) | 1.27 (1.12–1.43) | 48.4 | ||
Donor source | 0.027 | 0.616 | ||||||
Cadaveric | 138,516 (5) | 1.07 (1.06–1.07) | 0.00 | 41,284 (5) | 1.08 (1.04–1.11) | 66.4 | ||
Living and Cadaveric | 151,239 (7) | 1.05 (1.05–1.06) | 16.4 | 108,719 (2) | 1.09 (1.04–1.15) | 55.4 | ||
Geographical locations | 0.053 | 0.033 | ||||||
Europe | 138,988 (6) | 1.07 (1.06–1.08) | 0.00 | 1952 (4) | 1.32 (1.09–1.60) | 59.7 | ||
North America | 137,880 (4) | 1.05 (1.04–1.06) | 2.1 | 145,351 (2) | 1.07 (1.04–1.10) | 0 | ||
Asia | 225 (1) | 1.24 (1.00–1.55) | – | 2700 (1) | 1.23 (1.05–1.45) | – | ||
Oceania | 12,662 (1) | 1.07 (1.03–1.12) | – | 0 | – | – | ||
Year period | 0.175 | 0.026 | ||||||
Prior to 1995 | 103,915 (6) | 1.06 (1.05–1.07) | 0.00 | 148,051 (3) | 1.08 (1.04–1.12) | 26.8 | ||
Not prior to 1995 | 185,626(5) | 1.06 (1.05–1.08) | 60.1 | 4054 (4) | 1.36 (0.98–1.88) | 59.7 | ||
NR | 214 (1) | 0.83 (0.51–1.34) | – | – | – | – | – | – |