Short term and Long term Survival Rate and Risk Factors of Graft Rejection after Deceased Donor Kidney Transplantation: A Systematic Review and Meta-Analysis

Introduction: The purpose of the current meta-analysis was to determine the short-term and long-term graft survival and patient survival from the deceased donors, and determine the prognostic factors.Methods: PubMed, Scopus, and Google Scholar databases were searched in March 2019 to obtain articles that report short-term and/or long-term graft and patient survival. The study also includes articles that analyzed the hazard ratio (HR) of graft rejection or patient death for deceased donor risk-related factors. The measures in this study could be summarized as the survival rate and the HR of graft rejection and patient death.Results: In the final analysis, 75 articles were included. The 1- and 5-year graft survival were 90% and 76%, and patient survival was 95% and 85% respectively. The 1- and 5-year graft survival in transplant donation after brain death (DBD) for recipients were 92% and 79% and for patient survival was 94% and 90% respectively. The 1- year graft and patient survival in donation after circulatory death (DCD) recipients were 87% and 95%, respectively. Also, the 1- and 5-year graft survival in patient expanded-criteria donors (ECDs) were 88% and 68%, and patient survival was 93% and 87%, respectively. The 1-year graft survival in standard-criteria donors (SCDs) recipients was 93%, and 1- and 5-year patient survivals were 96% and 92%. Age of deceased donor, ECD kidney, and male sex were the significant prognostic factors for graft rejection.Conclusions: The findings of the first comprehensive meta-analysis of graft and patient survival of the deceased donor showed that the overall short-term and long-term graft and patient survival are desirable and confirm that ECD and DCD recipients have a poorer graft survival chance than standard donors.