Graft survival of en bloc versus single kidney transplantation from small pediatric donors: a meta-analysis with trial sequential analysis

Abstract

Background: Although renal transplantation from small pediatric donors can relieve the pressure of the shortage of organs, the graft survival differs among different studies. We conducted this meta-analysis to evaluate the prognosis of patients receiving en bloc versus single allograft from small pediatric donors. Methods: A systematic search in PubMed, Embase, and web of science was performed to identify relevant studies. Individual hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were combined to calculate the prognostic value. A cumulative meta-analysis based on publication year was also conducted. Trial sequential analysis (TSA) was performed to estimate the quantity of the evidence. Results: Seven studies consisting of 4,284 cases were included, and risk estimates from six of these studies were finally pooled for quantitative analysis. We found that compared with single kidney transplantation from small pediatric donors, en bloc kidney transplant suggested a better graft outcome of recipients (HR=0.57, 95% CI: 0.49–0.67). The findings in the current study were based on sufficient evidence by TSA. Furthermore, no evidence of publication bias in the meta-analysis was noted. Conclusions: En bloc kidney transplantation from small pediatric donors was significantly associated with a superior graft survival when compared with single kidney transplant.