Impact of acute kidney injury in donors on renal graft survival: a systematic review and Meta-Analysis

Figures & data

Figure 1. Flow diagram of identification of studies.

Table 1. Characteristics of the studies included in this meta-analysis.

Authors/year of publication	Country	Study design	Gender (male/female)	Mean age [year]	Donors		Follow-up [month]	Outcomes assessed
					AKI	Non-AKI
Rodrigo/2010 [15]	Spain	Cohort study	AKI: 12/7 Non-AKI: 87/70	AKI: 46.3 ± 13.2 Non-AKI: 45.8 ± 16.7	19	157	NA	DGF, acute rejection
Kolonko/2011 [20]	Poland	Cohort study	AKI: 6/4 Non-AKI: 36/15	AKI: 50 Non-AKI: 43	10	51	49 ± 18	DGF, graft survival
Farney/2013 [21]	USA	Cohort study	AKI: 64/20 Non-AKI: 159/124	AKI: 36 ± 13 Non-AKI: 35 ± 15	84	283	6–70	DGF, graft survival, PNF
Jung/2013 [22]	Korea	Cohort study	AKI: 32/4 Non-AKI: 11/7	AKI: 45.67 ± 14.27 Non-AKI: 50.39 ± 25.18	36	18	23.2 ± 10.4	Graft survival
Jacobi /2014 (S) [23] Jacobi /2014 (E) [23]	Germany Germany	Cohort study Cohort study	AKI: 18/8 Non-AKI: 119/63	AKI: 50.4 ± 10.2 Non-AKI: 48.3 ± 11	26	182	12	DGF, graft survival, PNF, hospital stay, eGFR
			AKI:27/10 Non-AKI: 98/39	AKI: 60.1 ± 10.4 Non-AKI: 61.7 ± 10.8	37	137
Lee/2014 [12]	Korea	Cohort study	AKI:3/11 Non-AKI: 79/34	AKI: 43.3 ± 13.8 Non-AKI: 41.1 ± 14.6	43	113	NA	DGF, graft survival, eGFR
Yu/2014 [24]	China	Cohort study	AKI: 14/5 Non-AKI: 27/11	AKI: 40 ± 9.8 Non-AKI: 35 ± 12.2	19	38	12	DGF, acute rejection, eGFR
Yuan/2014 [25]	China	Cohort study	AKI: 27/12 Non-AKI: 48/12	AKI: 37 ± 15.2 Non-AKI: 37.5 ± 13.5	29	60	7–26	DGF, acute rejection, eGFR
ALI/2015 [26]	Saudi Arabia	Cohort study	AKI: 83/18 Non-AKI: 146/14	AKI: 36.7 ± 11.0 Non-AKI: 35.0 ± 13.0	101	160	120	DGF, graft survival, acute rejection, hospital stay
Benck/2015 [27]	Germany	Cohort study	AKI: 25/8 Non-AKI: 28/37	AKI: 53 ± 13 Non-AKI: 54.8 ± 15.5	33	65	NA	DGF
Hall/2015 [11]	USA	Cohort study	AKI: 216/126 Non-AKI: 613/414	41	342	1027	20	DGF
Heilman/2015 (S) [10] Heilman/2015 (E) [10]	USA USA	Cohort study Cohort study	AKI: 108/31 Non-AKI: 288/184	AKI: 32.3 ± 13.2 Non-AKI: 34.5 ± 15.4	139	472	19.6–41.4	DGF, graft survival, acute rejection, eGFR
			AKI: 17/6 Non-AKI: 71/66	AKI:56.6 ± 9.1 Non-AKI:61.6 ± 9.2	23	137	12.3–23.8
Boffa/2017 [28]	United Kingdom	Cohort study	NA	Over 18	1869	9350	NA	DGF, graft survival, PNF
Kim/2017 [29]	Korea	Cohort study	AKI: 53/51 Non-AKI: 103/78	AKI: 49.1 ± 11.3 Non-AKI: 46.5 ± 8.0	104	181	NA	DGF, graft survival, eGFR

AKI: Acute kidney injury; non-AKI: nonacute kidney injury; DGF: delayed graft function; PNF: primary nonfunction; eGFR: estimated glomerular filtration rate; NA: not available; S: standard criteria donor; E: expanded criteria donor.

Table 2. Methodological quality of cohort studies included in the meta-analysis^a.

First author	Representativenessof the exposedcohort	Selectionof theunexposedcohort	Ascertainmentof exposure	Outcome ofinterest not presentat the start ofthe study	Control forimportant factoror additional factor	Outcomeassessment	Follow-uplong enoughfor outcomesto occur	Adequacy offollow-upof cohorts	Total qualityscores
Rodrigo/2010	⋆	⋆	⋆	⋆	—	⋆	⋆	—	5
Kolonko/2011	⋆	⋆	⋆	⋆	—	⋆	⋆	⋆	6
Farney/2013	⋆	⋆	⋆	⋆	—	⋆	⋆	⋆	6
Jung/2013	⋆	⋆	⋆	⋆	—	⋆	⋆	⋆	6
Jacobi/2014	⋆	⋆	⋆	⋆	—	⋆	⋆	⋆	6
Lee/2014	⋆	⋆	⋆	⋆	—	⋆	⋆	—	5
Yu/2014	⋆	⋆	⋆	⋆	—	⋆	⋆	⋆	6
Yuan/2014	⋆	⋆	⋆	⋆	—	⋆	⋆	⋆	6
ALI/2015	⋆	⋆	⋆	⋆	—	⋆	⋆	⋆	6
Benck/2015	⋆	⋆	⋆	⋆	—	⋆	⋆	—	5
Hall/2015	⋆	⋆	⋆	⋆	—	⋆	⋆	⋆	6
Heilman/2015	⋆	⋆	⋆	⋆	—	⋆	⋆	⋆	6
Boffa/2015	⋆	⋆	⋆	⋆	—	⋆	⋆	—	5
Kim/2015	⋆	⋆	⋆	⋆	—	⋆	⋆	—	5

^a A study could be awarded a maximum of one star for each item except for the item. Control for important factor or additional factor.

Figure 2. Forest plots showing the allograft survival and hospital stay after kidney transplantation in the AKI and non-AKI groups. (A) Allograft survival; (B) hospital stay.

Figure 3. Comparison of clinical outcomes in allograft function after kidney transplantation between the AKI and non-AKI groups. (A) DGF; (B) eGFR; (C) PNF; (D) acute rejection.

Figure 4. Funnel plot for publication bias test. Each point represents a separate study for the indicated association. (A) Allograft survival; (B) DGF; (C) eGFR.

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