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

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.

Acute kidney injury after hip fracture in organ transplant recipients

“…The present study proved that AKI occurred more commonly in the KT group than in the nontransplantation group even though NSAIDS were not used. A recent systematic review noted that the odds of postoperative AKI were higher in kidney transplant patients than in the nontransplantation group, and the odds were highest after orthopedic surgery, being 15.26 30 . Choi et al 31 .…”

“…A recent systematic review noted that the odds of postoperative AKI were higher in kidney transplant patients than in the nontransplantation group, and the odds were highest after orthopedic surgery, being 15.26. 30 Choi et al 31 identified that solid organ transplantation was an independent predictor of postoperative AKI in patients undergoing total hip arthroplasty due to avascular necrosis of femoral head. The incidence of AKI in the present study was higher than that in the previous study (39.1% vs. 28.8%).…”

Big Data-Enabled Analysis of Factors Affecting Patient Waiting Time in the Nephrology Department of a Large Tertiary Hospital

“…This study shows that disease type 4 (after renal transplant) had a shorter waiting time for admission than other disease types. This is because in patients with a after renal transplant, taking immunosuppressants leads to a decrease in immunity, resulting in rapid progression of infections and other complications, and an increased probability of systemic damage [ 41 , 42 ]. Lengthy waiting times will seriously endanger their life, so the waiting time is shorter than those of other disease types.…”

Akutes Nierenversagen

“…Bei geplanten Herzoperationen ist ein HbA 1c -Wert unter 7 % bei Menschen mit Diabetes mit einer erniedrigten Inzidenz einer akuten Nierenschädigung assoziiert [ 3 ]. Nierentransplantierte mit Diabetes mellitus Typ 2 haben bei geplanten operativen Eingriffen insgesamt ein erhöhtes Risiko, insbesondere auch für ein akutes Nierenversagen [ 16 ].…”