Twenty comparative studies were included in the review of the evaluation of the relative clinical effectiveness of MP and CS. Only in one of these was the allocation properly randomised.
Evaluation of the relative clinical effectiveness of MP and CS.
The quality of the included studies was generally very poor: only four studies scored 2 out of 5, seven scored 1 and nine scored 0.
Fifteen studies (1,154 kidneys or patients) were combined in the meta-analysis of DGF. The results suggested a 20% reduction in DGF with MP compared with CS (pooled RR 0.804, 95% CI: 0.672, 0.961, P=0.017). It was unclear from the review whether or not this was subject to heterogeneity (value not reported), although the authors stated that they conducted subgroup meta-analyses because of heterogeneity. The results of the subgroup analyses follow; whether there was any heterogeneity in these pooled studies was not reported.
Non-heart-beating donors (3 studies): there was no significant difference between MP and CS in the incidence of DGF (RR 0.847, 95% CI: 0.653, 1.098, P=0.21).
Heart-beating donors (5 studies): there was a statistically significant reduction in DGF with MP compared with CS (RR 0.718, 95% CI: 0.572, 0.903, P=0.005).
Donor status not specified (number of studies not stated): there was no significant difference between MP and CS in the incidence of DGF (RR 0.865, 95% CI: 0.587, 1.275, P=0.46).
Use of University of Wisoconsin solution as perfusate (2 studies): there was a statistically significant reduction in DGF with MP compared with CS (RR 0.703, 95% CI: 0.524, 0.943, P=0.019).
Studies of second and subsequent transplant (5 studies): the was no significant difference in DGF with MP compared with CS (RR 0.863, 95% CI: 0.667, 1.116, P=0.26).
All of the studies with a mean ischaemia time of greater than 24 hours reported a RR of less than 1 for DGF.
Seven studies (420 patients) were combined in the meta-analysis of 1-year graft survival. There was no difference between MP and CS (pooled RR 1.025, 95% CI: 0.963, 1.090, P=0.44); no heterogeneity was reported.
Can the use of MP allow valid testing of kidney viability prior to transplantation?
Eighteen studies were reported for this part of the review. Overall, there was little evidence that non-viable kidneys can be accurately identified when on MP. Further details were provided.