Kute Vivek B, Rela Mohamed, Gulati Sanjeev, Bhalla Anil K, Abraham Georgi, Chauhan Sanshriti, Mishra Vineet, Meshram Hari Shankar
From the Department of Nephrology and Transplantation, Institute of Kidney Diseases and Research Center, Dr. H. L. Trivedi Institute of Transplantation Sciences, Ahmedabad, India.
Exp Clin Transplant. 2022 Dec;20(12):1058-1068. doi: 10.6002/ect.2022.0207.
There is no systematic review and meta- analysis for pediatric solid-organ transplants in India. The objective of the study was to collect high-evidence data in this regard.
A systematic review and meta- analysis was performed for pediatric solid-organ transplants in India. We used the search engines of PubMed, Google Scholar, PubMed Central, Embase, and MEDLINE from beginning of data availability until April 26, 2022. Data from 2 participating centers were also used. Analyses were performed by the DerSimonian random model.
Of 50 000 primary searches, only 31 studies were included for analysis. In total, data for pediatric kidney (n = 1057), liver (n = 914), and heart (n = 117) were reported. For the pediatric kidney, the 1-year, 5-year, and 10-year patient survival rates were 96% (range, 93%-99%; I² = 91.17%, H² = 11.33, P < .01), 90% (range, 85%-94%; I² = 93.54%, H² = 15.47, P < .01), and 75% (range, 62%-88%; I² = 97.36%, H² = 37.82, P < .01), respectively. The 1-year, 5-year, and 10-year renal graft survival rates were 93% (range, 90%-96%; I² = 63.82, H² = 2.76, P < .01), 83% (range, 76%-89%; I² = 86.39%, H² = 7.35, P < .01), and 66% (range, 57%-75%; I² = 81.68%, H² = 5.46, P < .01), respectively. The acute rejection rate was 23% (range, 20%-27%; I² = 5.44%, H² = 1.06, P = .39). For the pediatric liver transplant, the 1-year and 5-year survival rates were 92% (range, 89%-95%; I² = 49.96%, H² = 2, P < .04) and 88% (range, 85%-90%; I² = 0; H² = 1, P = .72), respectively.
The outcomes of pediatric solid-organ transplants in India are comparable to those of the Western world. However, cause of graft loss and patient death is largely attributed to infections, unlike the experiences reported in the West. An effective registry is a primary pillar to expand pediatric solid- organ transplants in India.
印度尚无关于小儿实体器官移植的系统评价和荟萃分析。本研究的目的是收集这方面的高证据数据。
对印度小儿实体器官移植进行了系统评价和荟萃分析。我们使用了PubMed、谷歌学术、PubMed Central、Embase和MEDLINE的搜索引擎，搜索时间从数据可获取开始至2022年4月26日。还使用了来自2个参与中心的数据。采用DerSimonian随机模型进行分析。
在50000次初步检索中，仅纳入31项研究进行分析。总共报告了小儿肾脏（n = 1057）、肝脏（n = 914）和心脏（n = 117）的数据。对于小儿肾脏，1年、5年和10年的患者生存率分别为96%（范围93%-99%；I² = 91.17%，H² = 11.33，P <.01）、90%（范围85%-94%；I² = 93.54%，H² = 15.47，P <.01）和75%（范围62%-88%；I² = 97.36%，H² = 37.82，P <.01）。1年、5年和10年的肾移植生存率分别为93%（范围90%-96%；I² = 63.82，H² = 2.76，P <.01）、83%（范围76%-89%；I² = 86.39%，H² = 7.35，P <.01）和66%（范围57%-75%；I² = 81.68%，H² = 5.46，P <.01）。急性排斥率为23%（范围20%-27%；I² = 5.44%，H² = 1.06，P =.39）。对于小儿肝移植，1年和5年生存率分别为92%（范围89%-95%；I² = 49.96%，H² = 2，P <.04）和88%（范围85%-90%；I² = 0；H² = 1，P =.72）。
印度小儿实体器官移植的结果与西方世界相当。然而，与西方报道的情况不同，移植物丢失和患者死亡的原因主要归因于感染。有效的登记系统是印度扩大小儿实体器官移植的主要支柱。
