Effect of pretransplant dialysis modalities on pancreas-kidney transplant outcomes: A systematic review and meta-analysis

Abstract

Background: The impact of different pre-transplant dialysis modalities on post-transplant outcomes for pancreas-kidney transplantation is currently unclear. This study aims to assess the association between pretransplant dialysis modalities (hemodialysis and peritoneal dialysis) and outcomes following pancreas-kidney transplantation. Methods: We searched PubMed, EMBASE, and the Cochrane Library for relevant studies published from inception until December 1, 2023. We included studies that examined the relationship between pre-transplant dialysis modalities and clinical outcomes for pancreas-kidney transplantation. The primary outcomes considered were patient, pancreas and kidney graft survival, and intra-abdominal infection. Results: A total of 13 studies involving 1503 pancreas-kidney transplant recipients were included. Pretransplant hemodialysis was associated with improved pancreas graft survival (hazard ratio = 0.71, 95% confidence interval [CI]: 0.51 - 0.99, I² = 12%) and a decreased risk of intra-abdominal infection (odds ratio [OR] = 0.69, 95% CI: 0.51 – 0.93, I² = 5%). However, no significant association was found between the dialysis modalities and patient or kidney graft survival. Furthermore, pre-transplant hemodialysis was linked to a reduced risk of anastomotic leak (OR = 0.32, 95% CI: 0.161 – 0.68, I² = 0%) and graft thrombosis (OR = 0.56, 95% CI: 0.33 – 0.96, I² = 20%). Conclusion: Pre-transplant hemodialysis is the preferred dialysis modality while awaiting pancreas-kidney transplantation, although well-designed prospective studies are needed to confirm these findings.