小柯机器人

英国伯明翰大学Adnan Sharif团队对接受移植与等待移植的肾衰竭患者存活率进行了荟萃分析。相关论文发表在2022年3月1日出版的《英国医学杂志》上。

为了探讨肾移植与肾透析对预先分层的候补肾衰竭患者的生存益处，研究组在MEDLINE、Ovid Embase、科学引文索引、ClinicalTrials.gov等大型数据库中检索从建库至2021年3月1日的临床试验，筛选出所有针对等待移植手术的肾衰竭患者，评估移植和透析全因死亡率的比较研究。由两名独立评审员提取数据，并评估纳入研究的偏倚风险。荟萃分析使用DerSimonian-Laird随机效应模型，异质性通过亚组分析、敏感性分析和荟萃回归进行调查。

该研究共确定了无随机对照试验的48项观察性研究，涉及1245850名患者。总体来说，与透析相比，92%（n=44/48）的研究报告了与移植相关的长期（至少一年）生存益处。然而，其中有11项研究发现，与继续透析相比，移植在统计学上没有显著益处。在18项适用于荟萃分析的研究中，肾移植显示了生存益处（风险比为0.45），即使在亚组/敏感性分析或荟萃回归分析后仍存在显著的异质性。

研究结果表明，对于大多数肾衰竭患者来说，肾移植仍然是降低全因死亡率的最佳治疗方式，但某些亚组可能缺乏生存益处。鉴于供体器官持续短缺，需要进一步的证据来更好地为肾衰竭患者的决策提供信息。

附：英文原文

Title: Survival for waitlisted kidney failure patients receiving transplantation versus remaining on waiting list: systematic review and meta-analysis

Author: Daoud Chaudhry, Abdullah Chaudhry, Javeria Peracha, Adnan Sharif

Issue&Volume: 2022/03/01

Abstract:

Objectives To investigate the survival benefit of transplantation versus dialysis for waitlisted kidney failure patients with a priori stratification.

Design Systematic review and meta-analysis.

Data sources Online databases MEDLINE, Ovid Embase, Web of Science, Cochrane Collection, and ClinicalTrials.gov were searched between database inception and 1 March 2021.

Inclusion criteria All comparative studies that assessed all cause mortality for transplantation versus dialysis in patients with kidney failure waitlisted for transplant surgery were included. Two independent reviewers extracted the data and assessed the risk of bias of included studies. Meta-analysis was done using the DerSimonian-Laird random effects model, with heterogeneity investigated by subgroup analyses, sensitivity analyses, and meta-regression.

Results The search identified 48 observational studies with no randomised controlled trials (n=1245850 patients). In total, 92% (n=44/48) of studies reported a long term (at least one year) survival benefit associated with transplantation compared with dialysis. However, 11 of those studies identified stratums in which transplantation offered no statistically significant benefit over remaining on dialysis. In 18 studies suitable for meta-analysis, kidney transplantation showed a survival benefit (hazard ratio 0.45, 95% confidence interval 0.39 to 0.54; P<0.001), with significant heterogeneity even after subgroup/sensitivity analyses or meta-regression analysis.

Conclusion Kidney transplantation remains the superior treatment modality for most patients with kidney failure to reduce all cause mortality, but some subgroups may lack a survival benefit. Given the continued scarcity of donor organs, further evidence is needed to better inform decision making for patients with kidney failure.

DOI: 10.1136/bmj-2021-068769

Source: https://www.bmj.com/content/376/bmj-2021-068769

BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
官方网址：http://www.bmj.com/
投稿链接：https://mc.manuscriptcentral.com/bmj