Allograft Nephrectomy versus Non-Allograft Nephrectomy after Failed Renal Transplantation: A Systematic Review by Updated Meta-Analysis.

BACKGROUND: There is limited evidence regarding the impact of allograft nephrectomy (AN) on the long-term outcome of subsequent kidney re-transplantation compared to no prior allograft nephrectomy. The aim of the present study was to conduct a systematic review and meta-analysis to estimate the accumulation of evidence over time. Primary outcomes were 5-year graft and patient survival.

METHODS: Cochrane library, Google scholar, Pubmed, Medline and Embase were systematically searched. Meta-analysis was conducted using both fixed- and random-effects models. Study quality was assessed in duplicate using the Newcastle-Ottawa scale RESULTS: Sixteen studies were included, with a total of 2256 patients. All included studies were retrospective and comparative. There was no significant difference in 5- year graft survival (GS) [Hazard Ratio (HR)=1.11, 95% Confidence Intervals (CI): 0.89, 1.38, p=0.37, I2 =10%) or in 5-year patient survival (PS) (HR=0.70, 95%CI: 0.45, 1.10, p=0.12, I2 =0%]. Patients in the AN cohort were significantly younger than patients in the non-allograft nephrectomy(NAN) cohort by one year. Prior allograft nephrectomy was associated with a significantly higher risk of delayed graft function (DGF), acute rejection, primary nonfunction (PNF), percent of panel reactive antibodies (% PRA), and allograft loss of the subsequent transplant CONCLUSION: Although, DGF, % PRA, acute rejection and primary nonfunction rates were significantly higher in the AN cohort; allograft nephrectomy prior to re-transplantation had no significant association with five-year graft and patient survival.