Postoperative outcomes of kidney transplant recipients undergoing non-transplant-related elective surgery: a systematic
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RESEARCH ARTICLE
Open Access
Postoperative outcomes of kidney transplant recipients undergoing nontransplant-related elective surgery: a systematic review and meta-analysis Dharmenaan Palamuthusingam1,2,3*, Kuhan Kunarajah4, Elaine M. Pascoe5, David W. Johnson2,6,7, Camel M. Hawley2,6 and Magid Fahim2,6
Abstract Background: 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. Methods: 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. Results: 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. (Continued on next page)
* Correspondence: [email protected]; [email protected] 1 Metro South Integrated Nephrology and Transplant Services, Logan Hospital, Armstrong Road & Loganlea Road, Meadowbrook, Queensland 4131, Australia 2 Faculty of Medicine, University of Queensland, St Lucia, Queensland 4072, Australia Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by stat
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