Original Articles
Systematic Review: Kidney Transplantation Compared With Dialysis in Clinically Relevant Outcomes

https://doi.org/10.1111/j.1600-6143.2011.03686.xGet rights and content
Under a Creative Commons license
open archive

Individual studies indicate that kidney transplantation is associated with lower mortality and improved quality of life compared with chronic dialysis treatment. We did a systematic review to summarize the benefits of transplantation, aiming to identify characteristics associated with especially large or small relative benefit. Results were not pooled because of expected diversity inherent to observational studies. Risk of bias was assessed using the Downs and Black checklist and items related to time-to-event analysis techniques. MEDLINE and EMBASE were searched up to February 2010. Cohort studies comparing adult chronic dialysis patients with kidney transplantation recipients for clinical outcomes were selected. We identified 110 eligible studies with a total of 1 922 300 participants. Most studies found significantly lower mortality associated with transplantation, and the relative magnitude of the benefit seemed to increase over time (p < 0.001). Most studies also found that the risk of cardiovascular events was significantly reduced among transplant recipients. Quality of life was significantly and substantially better among transplant recipients. Despite increases in the age and comorbidity of contemporary transplant recipients, the relative benefits of transplantation seem to be increasing over time. These findings validate current attempts to increase the number of people worldwide that benefit from kidney transplantation.

Key words:

Cardiovascular events
dialysis
hospitalization
kidney transplantation
mortality
quality of life

Abbreviations:

ESRD
end-stage renal disease
EQ-5D
European quality of life-5 dimensions
GHQ
general health questionnaire
HR
hazard ratio
HUI
health utility index
KDQoL
kidney disease quality of life
QoL
quality of life
SES
socio-economic status
SF-36
Medical Outcomes Study 36-item short-form health survey
SIP
sickness impact profile
TTO
time trade off
WHO-QoL
World Health Organization quality of life
15D
Finnish 15 dimensions

Cited by (0)