Impact of polycystic kidney disease on outcomes after renal transplantation: systematic review and meta-analysis

Polycystic kidney disease (PKD) represents one of the most prevalent inherited renal disorders and constitutes the fourth leading etiology of end-stage kidney disease (ESKD). While renal transplantation remains the optimal therapeutic intervention for ESKD, existing evidence regarding post-transplant survival rates and graft loss in PKD recipients remains contentious. This systematic review incorporated studies from PubMed, Scopus, and Embase databases, with a preregistered protocol on PROSPERO (CRD420251002570). We evaluated the impact of PKD on post-transplant outcomes through comparative analyses of patient survival and graft survival at 1-, 5-, and 10-year intervals between PKD and non-PKD cohorts. Secondary outcomes included complication profiles. Methodological quality was appraised using the ROBINS-I tool for non-randomized studies. From 1,187 screened records, 23 studies were eligible for inclusion. Meta-analysis demonstrated superior 1-year patient survival in PKD kidney transplant recipients (OR 1.30, 95% CI: 1.08-1.56; 19 studies, I²=0.0%) and enhanced 10-year graft survival (OR 1.60, 95% CI: 1.52-1.62; 20 studies, I²=73.5%) compared to non-PKD counterparts. Subgroup analyses revealed amplified survival advantages in retrospective studies (OR 1.67, 95% CI: 1.35-2.07; 7 studies, I²=23.6%) and cohorts with unspecified donor types (OR 1.27, 95% CI: 1.05-1.53; 13 studies, I²=0.0%). Notably, PKD recipients exhibited higher incidence of post-transplant diabetes mellitus (OR 1.61, 95% CI: 1.40-1.81; I²=85.4%), while acute rejection episodes, infectious complications, and malignancy rates showed no intergroup divergence. PKD kidney transplant recipients demonstrate favorable short-term survival and long-term graft retention compared to non-PKD patients. However, residual confounding from donor characteristics, sample size heterogeneity, and methodological variations necessitate cautious interpretation.