Department of Urology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Korea.
INTO Newton A-Level, University of East Anglia, Norwich, UK.
Int Urol Nephrol. 2021 Aug;53(8):1563-1581. doi: 10.1007/s11255-021-02854-2. Epub 2021 May 6.
To date, several studies have reported inconsistent findings regarding the mortality risk faced by living kidney donors and controls. Our study assessed the methodological quality of previous studies and performed an updated meta-analysis of the mortality risk.
Comprehensive literature searches were conducted involving the PubMed, Embase, and Cochrane databases through September 2020. The search terms used included 'living donor' and 'kidney transplantation' and 'kidney donor' and 'mortality' or 'death' or 'survival'. We evaluated the risk of bias in such studies using ROBINS-I tool. Mortality risk was analyzed using OR and HR.
The qualitative review involved 18 studies and the meta-analysis included nine studies. We identified 3 studies with an overall risk of bias rated as "Low", 2 studies rated as "Moderate", 8 studies rated as "Serious", and 5 studies rated as "Critical". The pooled overall mortality risk in the meta-analysis was 0.984 (95% CI: 0.743, 1.302). In the subgroup analysis of HR and OR, the summary effect estimates did not reach statistical significance. The meta-regression analysis revealed that the donor group of more than 60,000 (1.836, 95% CI: 0.371, 6.410) carried a significantly high mortality risk compared with the donor group of less than 60,000 (0.810, 95% CI: 0.604, 1.086) (P = 0.007). The number of total patients was associated with slightly elevated mortality risks (0.796 for < 10,000, 0.809 for 10,000-60,000, and 1.852 for > 60,000; P < .054).
Current evidence based on this systematic review suggests that the methodology of previous studies was inconsistent and also carried a high risk in several aspects. Updated meta-analysis showed that the mortality risk was not significantly different. Future studies with well-designed methodology are necessary.
迄今为止，已有多项研究报告了活体肾脏捐献者和对照者所面临的死亡风险的不一致结果。我们的研究评估了以往研究的方法学质量，并对死亡风险进行了更新的荟萃分析。
通过 2020 年 9 月的 PubMed、Embase 和 Cochrane 数据库进行全面的文献检索。使用的检索词包括“活体供体”和“肾移植”以及“肾供体”和“死亡率”或“死亡”或“生存”。我们使用 ROBINS-I 工具评估了这些研究的偏倚风险。使用 OR 和 HR 分析死亡率风险。
定性综述包括 18 项研究，荟萃分析包括 9 项研究。我们确定了 3 项总体偏倚风险评为“低”的研究、2 项评为“中度”的研究、8 项评为“严重”的研究和 5 项评为“关键”的研究。荟萃分析中总的死亡率风险为 0.984（95%CI：0.743，1.302）。在 HR 和 OR 的亚组分析中，汇总效应估计没有达到统计学意义。荟萃回归分析显示，与少于 60000 美元的供体组相比，供体组超过 60000 美元（1.836，95%CI：0.371，6.410）的死亡率风险显著较高（0.810，95%CI：0.604，1.086）（P=0.007）。总患者人数与死亡率风险略有升高相关（<10000 人时为 0.796，10000-60000 人时为 0.809，>60000 人时为 1.852；P<.054）。
基于本系统评价的现有证据表明，以往研究的方法学不一致，在几个方面也存在高风险。更新的荟萃分析显示死亡率风险没有显著差异。需要进行设计良好的方法学的未来研究。
