Key result
Kidney transplant status is linked to ~120% higher postoperative mortality after elective cardiac surgery.
Why the study?
Reliable estimates of the absolute and relative risks of postoperative complications in kidney transplant recipients undergoing elective surgery are needed to inform clinical practice.
Do kidney transplant recipients have increased odds of postoperative mortality and complications following elective surgery compared to non-transplanted patients?
Meta-Analysis (n=7,823,186)
Do kidney transplant recipients have increased odds of postoperative mortality and complications following elective surgery compared to non-transplanted patients?
Odds Ratio: 2.2 (95% CI 1.9–2.5)
Kidney transplant recipients undergoing elective surgery face significantly higher risks of postoperative mortality and acute kidney injury compared to non-transplanted patients, highlighting the need for specialized perioperative risk assessment.
Kidney transplant recipients face elevated postoperative mortality risk; supports specialized perioperative assessment but leaves open optimal risk-reduction strategies.
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. CONCLUSION: Kidney transplant recipients are at increased odds for postoperative mortality and acute kidney injury following elective surgery. This review also highlights the urgent need for further studies to better inform perioperative risk assessment to assist in planning perioperative care.
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Palamuthusingam et al. (2020) conducted a meta-analysis in Kidney transplant recipients undergoing non-transplant-related elective surgery (n=7,823,186). Kidney transplant recipient status vs. Non-transplanted patients was evaluated on Postoperative mortality (cardiac surgery) (OR 2.2, 95% CI 1.9-2.5). Kidney transplant recipients undergoing elective surgery had increased odds of postoperative mortality following cardiac surgery (OR 2.2) and general surgery (OR 2.2) compared to non-transplanted patients.
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