One hundred and ten cohort studies were included in the review (1,922,300 participants, range 39 to 468,681). Risk of bias was variable.
Seventy-six per cent of studies found a significantly lower risk of death with transplantation. Seven per cent of studies found a lower risk of death with dialysis. The magnitude of mortality benefit with transplantation tended to increase over time.
Most studies found that the risk of cardiovascular events was significantly reduced among transplant recipients. Risk of hospital-related infections appeared to be significantly reduced with transplant recipients but there was no clear difference in all-cause hospitalisations.
Quality of life was significantly and substantially better among transplant recipients (47% to 100% of cohort groups favoured transplantation).
Results of subgroup/moderator analysis were reported.