In the first step, we identified 16968 articles, after removing duplicate papers, and reviewed the title and abstract of 10786 them. Secondly, considering the exclusion criteria, we excluded 9986 articles and studied 923 full-text articles. According to our objectives and quality assessment of selected articles, 845 papers were withdrawn, and finally, 75 articles were included in the final analysis (Fig 1). Table 2 represents article information including author, country, research design, donor sex, male donor (%), donor mean age (year) ± SE, type of the deceased donor (DBD or DCD), criteria (ECD or SCD), donor BMI, sample size, patient survival rate, and graft survival rate.
Table 2. Characteristics of the studies included in this meta-analysis
Author/ year
|
country
|
design
|
Sex
|
Male donor (%)
|
Donor Mean age ± SE (years)
|
Type of deceased donor
|
Criteria (%)
|
Donor BMI
|
SS
|
Survival %
|
patient
|
graft
|
One year
|
Three years
|
Five years
|
One year
|
Three years
|
Five years
|
Kute et al. 2014 (29)
|
India
|
R.cohort
|
both
|
61.5
|
45.9
|
DBD
|
-
|
-
|
294
|
81.6
|
-
|
-
|
92.5
|
-
|
-
|
Augliene et al. 2017 (30)
|
Lithuania
|
R.cohort
|
both
|
61.1
|
44.1±15.8
|
DBD & DCD
|
ECD & SCD
|
-
|
186
|
-
|
-
|
-
|
93.5
|
90.0
|
-
|
Cardinal et al. 2005 (31)
|
Canada
|
R.cohort
|
both
|
-
|
42.0
|
DBD & DCD
|
-
|
-
|
256
|
93.0
|
-
|
74.0
|
88.0
|
-
|
67.0
|
Centellas-Perez et al. 2019 (32)
|
Spain
|
R.cohort
|
both
|
62.8
|
60.5±13.6
|
DBD:92.9,DCD:7.1
|
ECD & SCD
|
-
|
183
|
-
|
-
|
-
|
86.9
|
-
|
-
|
Cho et al. 2014(33)
|
Korea
|
R.cohort
|
both
|
-
|
42.0±14.0
|
DBD & DCD
|
-
|
-
|
136
|
-
|
-
|
-
|
99.2
|
97.3
|
95.5
|
Terasaki et al. 1998 (34)
|
United states
|
R.cohort
|
both
|
-
|
-
|
DBD & DCD
|
-
|
-
|
DBD:22680,DCD:276
|
-
|
-
|
-
|
DBD:85.7,DCD: 82.8
|
-
|
-
|
Czerwinski et al. 2016 (35)
|
Poland
|
Registry
|
both
|
-
|
-
|
DBD & DCD
|
|
|
15009
|
95.0
|
91.0
|
87.0
|
88.0
|
82.0
|
74.0
|
Kyllonen et al. 2000 (36)
|
Finland
|
R.cohort
|
both
|
62.8
|
38.8
|
DBD
|
-
|
-
|
1407
|
95.9
|
91.9
|
86.0
|
91.3
|
84.1
|
76.8
|
Laging et al. 2012 (37)
|
Netherlands
|
R.cohort
|
both
|
55.0
|
45.7±16.1
|
DBD & DCD
|
-
|
-
|
513
|
-
|
-
|
-
|
-
|
-
|
-
|
Lionaki et al. 2014 (38)
|
Greece
|
R.cohort
|
both
|
64.4
|
52.9±15.7
|
DBD & DCD
|
ECD:42.5, SCD: 57.5
|
|
334
|
-
|
-
|
ECD:93.7,SCD:96.4
|
-
|
-
|
-
|
McDonald et al. 2002 (39)
|
Australia
|
Registry
|
both
|
63.0
|
43.8
|
DBD & DCD
|
-
|
-
|
2362
|
-
|
-
|
-
|
91.0
|
85.0
|
78.0
|
Moers et al. 2009 (40)
|
Netherlands
|
Registry
|
both
|
45.0
|
67
|
DBD & DCD
|
-
|
-
|
1011
|
-
|
-
|
-
|
-
|
-
|
-
|
Mok et al. 2012 (41)
|
Singapore
|
R.cohort
|
both
|
63.3
|
44.7±11.7
|
DBD & DCD
|
ECD:72.6, SCD:14.2
|
-
|
332
|
96.7
|
94.8
|
91.5
|
89.8
|
85.9
|
80.8
|
Mukherjee et al. 2018 (42)
|
India
|
R.cohort
|
both
|
65.2
|
43.9±17.0
|
DBD & DCD
|
-
|
-
|
92
|
98.9
|
83.3
|
70.8
|
98.9
|
91.6
|
77.1
|
Nagaraja et al. 2012 (43)
|
United Kingdom
|
R.cohort
|
both
|
-
|
DBD: 52, DCD:46
|
DBD & DCD
|
-
|
-
|
DBD:52, DCD:46
|
DBD:95.0, DCD:96.0
|
-
|
-
|
DBD:88.0, DCD:96.0
|
-
|
-
|
Newstead et al. 1992 (44)
|
England
|
R.cohort
|
both
|
-
|
-
|
DBD & DCD
|
-
|
-
|
397
|
-
|
-
|
-
|
87.0
|
79.0
|
-
|
Noppakun et al. 2015 (45)
|
Thailand
|
Registry
|
both
|
73.1
|
34.7±13.3
|
DBD
|
-
|
-
|
1745
|
96.3
|
-
|
93.1
|
95.6
|
-
|
88.4
|
OKelly et al. 2001 (46)
|
Ireland
|
R.cohort
|
both
|
58.8
|
34.7
|
DBD & DCD
|
-
|
-
|
436
|
95.0
|
90.7
|
85.7
|
85.2
|
77.6
|
67.4
|
Pessione et al. 2003 (47)
|
France
|
R.cohort
|
both
|
65.7
|
41±13.7
|
DBD & DCD
|
-
|
-
|
7209
|
-
|
-
|
-
|
91.1
|
85.6
|
-
|
Salmela et al. 2001 (48)
|
Finland
|
R.cohort
|
both
|
-
|
-
|
DBD & DCD
|
-
|
-
|
1008
|
96.3
|
-
|
-
|
92.9
|
-
|
-
|
Saunders et al. 1984 (49)
|
USA
|
R.cohort
|
both
|
68.2
|
32.1±15.4
|
DBD & DCD
|
-
|
-
|
104
|
-
|
-
|
-
|
91.5
|
85.6
|
-
|
Savoye et al. 2007 (50)
|
France
|
Registry
|
both
|
58.7
|
54.8±14.9
|
DBD & DCD
|
ECD
|
-
|
2845
|
96.2
|
88.9
|
82.8
|
88.1
|
80.8
|
73.2
|
Sener et al. 2009 (51)
|
England
|
R.cohort
|
both
|
-
|
55
|
DBD & DCD
|
-
|
-
|
468
|
-
|
-
|
-
|
86.5
|
77.4
|
65.2
|
Stratta et al. 2016 (52)
|
USA
|
R.cohort
|
both
|
ECD:58.5,SCD:61.6
|
ECD:61.1±6.4, SCD: 37.0±13.8
|
DBD & DCD
|
ECD & SCD
|
ECD:28.1±6.1,SCD:26.7±7.8
|
ECD:354, SCD:589
|
ECD:93.7,SCD:96.3
|
-
|
-
|
ECD:83.3, SCD:91.7
|
-
|
-
|
Kandus et al. 2016 (53)
|
Slovenia
|
R.cohort
|
both
|
-
|
-
|
DBD & DCD
|
ECD
|
-
|
793
|
98.1
|
-
|
93.8
|
94.3
|
-
|
87.5
|
Jacobi et al. 2014 (54)
|
Germany
|
R.cohort
|
both
|
-
|
-
|
DBD & DCD
|
ECD & SCD
|
-
|
ECD:174, SCD:208
|
96.8
|
-
|
-
|
90.4
|
-
|
-
|
Heylen et al. 2017 (55)
|
Belgium
|
Registry
|
both
|
DBD:52.0,DCD:60.0
|
DBD:54,DCD:51
|
DBD & DCD
|
-
|
-
|
DBD:17006,DCD:1059
|
-
|
-
|
-
|
-
|
-
|
DBD:74.5,DCD:76.4
|
Heilman et al. 2015 (56)
|
USA
|
R.cohort
|
both
|
ECD:74.0,SCD:78.0
|
ECD:56.6±9.1,SCD:32.3±13.2
|
DBD
|
ECD & SCD
|
-
|
ECD:23,SCD:139
|
-
|
-
|
-
|
ECD:95.6,SCD:97.1
|
-
|
-
|
Hamed et al. 2015 (57)
|
UK
|
Registry
|
both
|
-
|
-
|
DBD & DCD
|
ECD & SCD
|
-
|
DBD:366,DCD:435
|
-
|
-
|
-
|
DBD:89.8,DCD:86.4
|
-
|
-
|
Gondos et al. 2013 (58)
|
Germany (Europe, white American, African American, Hispanic American)
|
Registry
|
both
|
-
|
-
|
DBD & DCD
|
-
|
-
|
Europe:23530, white American:15772, African American:11148, Hispanic American:5338
|
-
|
-
|
-
|
Europe:90.6, white American:91.1, African American:88.7, Hispanic American:91.5
|
-
|
Europe:56.6, white American:45.7, African American:33.7:48.2, Hispanic American
|
Fujita et al. 2014 (59)
|
Japan
|
R.cohort
|
both
|
63.4
|
45.7±16.7
|
DBD & DCD
|
-
|
-
|
350
|
-
|
-
|
-
|
97.0
|
-
|
85.0
|
Ferreira et al. 2017 (60)
|
Portugal
|
R.cohort
|
both
|
67.3
|
46.3±16.5
|
DBD & DCD
|
ECD & SCD
|
-
|
ECD:150,SCD:467
|
95.8
|
91.3
|
88.2
|
93.9
|
90.5
|
85.5
|
Ergün et al. 2019 (61)
|
Netherlands
|
R.cohort
|
both
|
-
|
54.0
|
DBD
|
ECD & SCD
|
24.5
|
ECD:696, SCD:1173
|
-
|
-
|
-
|
90.9
|
-
|
82.0
|
Emiroglu et al. 2005 (62)
|
Turkey
|
R.cohort
|
both
|
-
|
45.0
|
DBD & DCD
|
-
|
-
|
58
|
94.8
|
-
|
-
|
92.6
|
-
|
-
|
Aceto et al. 2019 (63)
|
Italy
|
R.cohort
|
both
|
62.0
|
46.7±17.0
|
DBD & DCD
|
-
|
-
|
87
|
95.4
|
-
|
-
|
96.5
|
-
|
-
|
ALI et al. 2015 (64)
|
Saudi Arabia
|
R.cohort
|
both
|
87.7
|
35.7±12.3
|
DBD & DCD
|
-
|
-
|
284
|
98.8
|
-
|
94.8
|
94.1
|
-
|
85.8
|
Butala et al. 2013 (65)
|
United States
|
Registry
|
both
|
59
|
-
|
DBD & DCD
|
-
|
-
|
73714
|
94.7
|
-
|
80.0
|
94.0
|
-
|
78.0
|
Chen et al. 2013 (66)
|
China
|
R.cohort
|
both
|
76.0
|
26.7±11.9
|
DCD
|
-
|
20.5±3.1
|
71
|
100
|
-
|
-
|
95.7
|
92.4
|
-
|
Farrugia et al. 2013 (67)
|
England
|
R.cohort
|
both
|
-
|
-
|
DBD & DCD
|
-
|
-
|
19688
|
96.2
|
-
|
-
|
-
|
-
|
-
|
Harada et al. 2009 (68)
|
Brazil
|
R.cohort
|
both
|
57.5
|
42.2
|
DBD & DCD
|
ECD & SCD
|
-
|
ECD:135,SCD:641
|
ECD:71.1,SCD:80.2
|
-
|
-
|
ECD:82.2,SCD:88.2
|
-
|
-
|
Hassanian et al. 2009 (5)
|
Canada
|
R.cohort
|
both
|
-
|
-
|
DBD & DCD
|
ECD & SCD
|
-
|
335
|
86.3
|
-
|
7.4
|
-
|
-
|
-
|
Hwang et al. 2014 (69)
|
Korea
|
R.cohort
|
both
|
ECD:67.7, SCD:65.2
|
ECD:56.8±6.3,SCD:37.5±13.5
|
DBD & DCD
|
ECD & SCD
|
ECD:23.1±3.1,SCD:22.7±3.4
|
ECD:31, SCD:164
|
ECD:96.8,SCD:98.1
|
|
ECD:89.3,SCD:89.0
|
ECD:93.5,SCD:93.8
|
-
|
ECD:76.3,SCD:89.2
|
Kang et al. 2018 (70)
|
Korea
|
R.cohort
|
both
|
45.0
|
37.2
|
DBD & DCD
|
-
|
-
|
127
|
98.4
|
96.8
|
95.9
|
96.8
|
91.2
|
84.7
|
Kim et al. 2014 (71)
|
Korea
|
R.cohort
|
both
|
ECD:12.6,SCD:24.1
|
ECD:62.5±10.5,SCD:42.7±11.7
|
DBD & DCD
|
ECD & SCD
|
-
|
ECD:14,SCD:31
|
ECD:92.9,SCD:87.1
|
-
|
-
|
ECD:92.8,SCD:87.1
|
-
|
-
|
Lee et al. 2010 (26)
|
Korea
|
R.cohort
|
both
|
57.4
|
31.3
|
DBD & DCD
|
-
|
-
|
216
|
-
|
-
|
-
|
-
|
-
|
-
|
Lewandowska et al. 2016 (72)
|
Poland
|
R.cohort
|
both
|
-
|
42.1±14.5
|
DBD
|
-
|
-
|
8206
|
-
|
-
|
87.5
|
-
|
-
|
74.4
|
Papalia et al. 2010 (73)
|
Italy
|
R.cohort
|
both
|
-
|
-
|
-
|
-
|
24.4±2.6
|
194
|
-
|
-
|
-
|
-
|
-
|
-
|
Papachristou et al. 2014 (74)
|
Greece
|
R.cohort
|
both
|
ECD:54.7,SCD:63.6
|
ECD:56.0,SCD:27.0
|
DBD & DCD
|
ECD & SCD
|
ECD:27.3±4.3, SCD:25.1±6.4
|
ECD:53,SCD:162
|
ECD:93.6,SCD:96.8
|
ECD:93.6,SCD:93.9
|
ECD:85.3,SCD:92.2
|
ECD:88.4,SCD:90.7
|
ECD:81.8,SCD:88.5
|
-
|
Noseworthy et al. 2004 (75)
|
Canada
|
R.cohort
|
both
|
-
|
-
|
DBD & DCD
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
Nakamura et al. 2018 (76)
|
Japan
|
R.cohort
|
both
|
-
|
DBD: 37.3±19.8,CDC:49.8±13.0
|
DBD & DCD
|
ECD & SCD
|
-
|
DBD:9,DCD:19
|
-
|
-
|
-
|
DBD:100,DCD:100
|
DBD:100,DCD:94.7
|
DBD:100,DCD:82.1
|
Molina et al. 2015 (77)
|
Spain
|
R.cohort
|
both
|
81.0
|
45.0±16.0
|
DBD & DCD
|
-
|
-
|
59
|
97.0
|
-
|
-
|
92.0
|
-
|
|
Malek-Hosseini et al. 2006 (78)
|
Iran
|
R.cohort
|
both
|
67.3
|
33.6±12.5
|
DBD & DCD
|
-
|
-
|
97
|
93.0
|
90.5
|
-
|
-
|
-
|
-
|
Tasaki et al. 2014 (79)
|
Japan
|
R.cohort
|
both
|
-
|
45.7
|
DBD & DCD
|
-
|
-
|
56
|
98.2
|
-
|
96.2
|
89.0
|
-
|
80.3
|
Sagban et al. 2014 (80)
|
Germany
|
R.cohort
|
both
|
-
|
52.0±16.2
|
DBD & DCD
|
-
|
-
|
1134
|
-
|
-
|
-
|
-
|
-
|
85.3
|
Sirivongs et al. 2004 (81)
|
Thailand
|
R.cohort
|
both
|
76.4
|
30.18±11.4
|
DBD & DCD
|
-
|
-
|
89
|
-
|
-
|
-
|
90.6
|
-
|
83.0
|
Tomita et al. 2017 (82)
|
Japan
|
R.cohort
|
both
|
ECD:62.0,SCD:55.3
|
ECD:60.4±8.2,SCD:38.8±15.0
|
DBD & DCD
|
ECD & SCD
|
-
|
ECD:50,SCD:47
|
100.0
|
-
|
92.9
|
100.0
|
-
|
93.5
|
WOO et al. 1998 (83)
|
United Kingdom
|
R.cohort
|
both
|
-
|
-
|
DBD & DCD
|
-
|
-
|
589
|
95.0
|
-
|
82.0
|
84.0
|
-
|
68.0
|
Zhang et al. 2018 (84)
|
China
|
R.cohort
|
both
|
-
|
-
|
DBD & DCD
|
-
|
-
|
524
|
-
|
-
|
-
|
94.9
|
91.3
|
91.3
|
Zhu et al. 2018 (85)
|
China
|
Registry
|
both
|
DBD:59.5,DCD:72.1
|
DBD:40.3±16.7,DCD:42.2±15.8
|
DBD & DCD
|
ECD & SCD
|
-
|
DBD:415,DCD:133
|
DBD:98.9,DCD:98.4
|
-
|
-
|
DBD:98.4,DCD:92.4
|
-
|
-
|
Ko et al. 2018 (86)
|
Korea
|
R.cohort
|
both
|
ECD:68.9,SCD:67.0
|
ECD:58.2±5.4,SCD: 41.7±10.9
|
DBD & DCD
|
ECD & SCD
|
-
|
ECD:90,SCD:200
|
|
|
|
|
|
|
Nakamura et al. 2017 (87)
|
Japan
|
Registry
|
both
|
-
|
49.6±15.0
|
DCD
|
-
|
-
|
589
|
95.5
|
92.9
|
90.9
|
85.6
|
80.4
|
75.1
|
Boer et al. 2002 (88)
|
Belgium
|
R.cohort
|
both
|
-
|
-
|
DBD & DCD
|
-
|
-
|
16
|
93.0
|
-
|
-
|
44.0
|
-
|
-
|
Davidson et al. 2019 (89)
|
South Africa
|
R.cohort
|
both
|
DBD:86.0,DCD:67.0
|
DBD:31.0,DCD:34.0
|
DBD & DCD
|
-
|
-
|
DBD:123,DCD:7
|
89.1
|
-
|
84.5
|
88.8
|
-
|
78.6
|
Gallinat et al. 2016 (90)
|
Germany
|
Registry
|
both
|
73.0
|
51.0
|
DBD & DCD
|
-
|
-
|
78
|
96.0
|
93.0
|
89.0
|
92.0
|
89.0
|
89.0
|
Lai et al. 2014 (91)
|
China
|
R.cohort
|
both
|
-
|
-
|
DBD & DCD
|
-
|
-
|
166
|
84.8
|
82.1
|
77.1
|
93.6
|
89.4
|
83.6
|
McLarena et al. 1999 (92)
|
UK
|
R.cohort
|
both
|
62.0
|
35
|
DBD & DCD
|
-
|
-
|
681
|
-
|
-
|
-
|
84.7
|
77.5
|
70.0
|
Nemati et al. 2014 (93)
|
Iran
|
R.cohort
|
both
|
-
|
-
|
DBD & DCD
|
-
|
-
|
103
|
95.1
|
95.4
|
-
|
97.0
|
67.4
|
-
|
Rezapour et al. 2017 (94)
|
Iran
|
R.cohort
|
both
|
67.0
|
-
|
DBD & DCD
|
-
|
-
|
120
|
-
|
-
|
-
|
90.8
|
-
|
-
|
Savdie et al. 1982 (95)
|
Australia
|
R.cohort
|
both
|
-
|
-
|
DBD & DCD
|
-
|
-
|
404
|
79.0
|
-
|
60.9
|
63.0
|
|
45.9
|
Seo et al. 2015 (96)
|
Korea
|
R.cohort
|
both
|
65.6
|
40.9±14.5
|
DBD & DCD
|
-
|
22.7±1.3
|
191
|
98.1
|
96.3
|
96.3
|
97.3
|
92.2
|
90.6
|
Dalinkevciene et al. 2010 (97)
|
Lithuania
|
R.cohort
|
both
|
-
|
-
|
DBD & DCD
|
-
|
-
|
159
|
97.0
|
9.0
|
94.0
|
85.0
|
82.0
|
71.0
|
Molmenti et al. 2016 (98)
|
Greece
|
Registry
|
both
|
60.6
|
50.1±13.0
|
DBD & DCD
|
-
|
-
|
61167
|
-
|
-
|
-
|
-
|
-
|
-
|
Simforoosh et al. 2011 (99)
|
Iran
|
R.cohort
|
both
|
60.8
|
28.9
|
DBD & DCD
|
-
|
-
|
138
|
96.0
|
-
|
-
|
93.0
|
-
|
-
|
Yoshida et al. 2002 (100)
|
Japan
|
R.cohort
|
both
|
-
|
40.2
|
DCD
|
|
|
107
|
85.7
|
-
|
77.0
|
-
|
-
|
-
|
Vergoulas et al. 2008 (101)
|
Greece
|
R.cohort
|
both
|
-
|
51.5±16.9
|
DBD & DCD
|
-
|
-
|
29
|
100.0
|
-
|
100.0
|
100.0
|
-
|
93.7
|
DBD: donor after brain death, DCD: donor after cardiac death, ECD: expanded-criteria donor, SCD: Standard-criteria donor, SS: sample size, R.cohort: retrospective cohort
Descriptive of included articles
In this meta-analysis, data of 249369 patients from 29 countries were analyzed. The largest sample size was from the Gondos et al. (58) study in Germany in 2013. They used the registry data to report the graft survival of 55778 patients of different ethnicities, such as European, African, African- American, and Hispanic. The smallest sample size belonged to the Nakamura et al. (87) study in Japan, which had examined 16 kidney transplants survival from cadaver donors. Thirteen studies were registry-based (35, 39, 40, 45, 50, 55, 58, 65, 76, 85, 90, 98, 102) and others were retrospective case studies. Table 3 shows the most important causes of deaths in the deceased donor reported by twenty-six articles. Trauma and cerebrovascular were the most common causes of death.
Table 3. Cause of donor death in the studies included in this meta-analysis
1 Author (Year)
|
Intracranial Bleeding
|
Trauma
|
Cerebrovascular
|
Judicial Death
|
Traffic Accident
|
Anoxia
|
Suicide
|
Brain Hemorrhage
|
Ischemic Brain Injury
|
Cardiovascular Disease
|
Respiratory Disease
|
Brain Tumor
|
Other
|
ALI et al. 2015(64)
|
-
|
15.7
|
32.6
|
-
|
34.1
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
17.6
|
Augliene et al. 2017(30)
|
-
|
35.6
|
63.3
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
1.1
|
Boer et al. 2002(88)
|
-
|
55.3
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
43.0
|
Butala et al. 2013(65)
|
-
|
40.0
|
41.0
|
-
|
-
|
15.0
|
-
|
-
|
-
|
-
|
-
|
-
|
3.0
|
Centellas-Perez et al. 2019(32)
|
-
|
16.4
|
65.6
|
-
|
-
|
13.1
|
-
|
-
|
-
|
-
|
-
|
1.1
|
3.8
|
Chen et al. 2013(66)
|
-
|
52.0
|
36.0
|
-
|
-
|
12.0
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
Ferreira et al. 2017(60)
|
-
|
15.5
|
31.4
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
53.1
|
Fujita et al. 2014(59)
|
-
|
36.0
|
55.4
|
-
|
-
|
-
|
6.5
|
-
|
-
|
-
|
-
|
-
|
2.1
|
Heylen et al. 2017(55)
|
-
|
23.1
|
68.4
|
-
|
-
|
5.9
|
-
|
-
|
-
|
-
|
-
|
-
|
2.4
|
Hwang et al. 2014(69)
|
|
30.7
|
56.9
|
-
|
-
|
-
|
7.1
|
-
|
-
|
-
|
-
|
-
|
4.6
|
Kim et al. 2014(71)
|
-
|
-
|
53.3
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
46.7
|
Ko et al. 2018(86)
|
-
|
26.3
|
57.5
|
-
|
-
|
-
|
3.8
|
-
|
-
|
-
|
-
|
-
|
12.5
|
Kute et al. 2014(29)
|
59.4
|
21.6
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
19.0
|
Kyllonen et al. 2000(36)
|
60.0
|
31.6
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
8.4
|
Lionaki et al. 2014(38)
|
-
|
-
|
56.7
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
43.3
|
Moers et al. 2009(40)
|
-
|
14.0
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
86.0
|
Mok et al. 2012(41)
|
-
|
16.3
|
67.8
|
13.3
|
|
-
|
-
|
-
|
-
|
|
|
|
2.7
|
Molina et al. 2015(77)
|
-
|
-
|
39.0
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
61.0
|
Nakamura et al. 2017(87)
|
-
|
16.4
|
54.3
|
-
|
-
|
5.9
|
-
|
-
|
-
|
1.9
|
2.6
|
1.6
|
17.1
|
Noppakun et al. 2015(45)
|
-
|
-
|
11.2
|
-
|
49.7
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
13.9
|
Papachristou et al. 2014(74)
|
-
|
37.2
|
-
|
-
|
-
|
-
|
-
|
48.4
|
7.4
|
0.9
|
-
|
-
|
6.1
|
Pessione et al. 2003(47)
|
-
|
-
|
44.5
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
55.5
|
Savoye et al. 2007(50)
|
-
|
-
|
62.5
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
37.5
|
Tasaki et al. 2014(79)
|
-
|
-
|
48.7
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
-
|
51.3
|
Tomita et al. 2017(82)
|
-
|
-
|
55.6
|
-
|
-
|
-
|
-
|
-
|
-
|
|
|
|
44.4
|
Seo et al. 2015(96)
|
-
|
31.4
|
56.0
|
-
|
-
|
-
|
7.3
|
-
|
-
|
-
|
-
|
-
|
4.7
|
Graft and patient survival rate
The one-year graft survival rate was 90% (95% CI: 89% to 92%). Two, three, five and ten-year graft survival rates were 80% (95% CI: 90% -70%), 82% (95% CI: 75% -88%), 76% (95% CI: 73% -79%) and 52% (48% -60%), respectively (Fig 2). One-year patient survival rate was 95% (95% CI: 94% -96%). This rate decreased to 83% (95% CI: 91% -74%), 85% (95% CI: 80% -89%), and 73% (95% CI: 57% -89%) after three, five, and ten years, respectively (Fig 3). Regardless of Savdia et al. (103) 10-year patient survival rate increased to 84%, but there were no significant changes in short-term patient and graft survival.
In figures 4, 5 and 6 the graft and patients survival based on the type of deceased donor (DCD and DBD) is shown. The rate of one-year graft and patient survival in DCD recipients were 87% (95% CI: 83%- 92%) and 95% (95% CI: 95%- 99%), respectively. One, five and fifteen-year graft survival rates in transplant recipients from DBD donor were 92% (95% CI: 88%- 96%), 79% (95% CI: 76%- 83%), and 65% (95% CI: 56%- 73%), respectively. One-year patient survival rate of transplant recipients from DBD was 94% (95% CI: 97%- 91%) and five-year survival rate was 90% (95% CI: 85% -95%). One, three and five-year graft survival rates in ECD recipients were 88% (95% CI: 85%- 91%), 78% (95% CI: 70%- 87%), and 68% (95% CI: 61), respectively (Fig 7). In the case of SCDs recipients one-year and three-year patient survival rate were respectively 93% (95% CI: 91%- 94%) and 80% (95% CI: 78%- 83%) (Fig 8). Also one-year patient survival rate in SCD kidneys was 96% (95% CI: 94%- 97%). In the same category, three and five-year survival rates were 86% (95% CI: 79%- 92%) and 87% (95% CI: 79%- 95%), respectively (Fig 9). The one and five-year patients survival in SCDs were 96% (95% CI: 93%- 98%) and 92% (95% CI: 86%- 98%), respectively (Fig 10).
Hazard Ratio
Although most of the studies have found that the HR of graft rejection and patient death risk factors are attributed to the recipient, few studies have been performed to determine the HR of risk factors associated with the deceased donor. Therefore, only three factors, including the age of the donor, ECD kidney and male sex, were included for analysis. HR of age of deceased donor was 1.01 (95% CI: 0.99 to 1.04) for graft rejection and patient death (Fig 11). ECD kidney was a risk factor for graft rejection (HR: 1.14, 95% CI: 1.00, 1.27) (Fig 12). Male sex was a significant protective factor in patient survival rate. According to the results shown in graph 13, the risk of death in men had an HR of 0.86 (95% CI: 75, 97). However, the male sex does not affect the survival of the kidney transplant (HR=0.95, 95% CI: 0.83, 1.06) (Fig 13).