Table 2.
Meta-analysis of risk factors and outcomes for IgAN recurrence.
| Risk factors or outcomes | No. of studies | n | Heterogeneity | Effects model | ES | ES [95% CI] | Z | P | Egger’s test, P | |
|---|---|---|---|---|---|---|---|---|---|---|
| I² | P | |||||||||
| Recipient | ||||||||||
| Age at KT (year) | 28 | 3248 | 71.60% | < 0.0001 | R | MD | -4.27 [-5.76, -2.78] | -5.63 | < 0.0001 | 0.7522 |
| Age at KT (per year) | 9 | 3519 | 29.30% | 0.1848 | F | RR | 0.96 [0.95, 0.97] | -8.31 | < 0.0001 | – |
| Recipient sex (male) | 27 | 3795 | 6.40% | 0.3693 | F | RR | 1.17 [1.01, 1.35] | 2.07 | 0.0380 | 0.1139 |
| Recipient body mass index (kg/cm²) | 4 | 677 | 81.80% | 0.0009 | R | MD | -1.53 [-3.75, 0.69] | -1.35 | 0.1762 | – |
| Recipient body mass index (per 1 kg/cm²) | 2 | 722 | 0.00% | 1.0000 | F | RR | 0.96 [0.92, 1.02] | -1.68 | 0.0936 | – |
| Donor | ||||||||||
| Donor sex (male) | 7 | 983 | 0.00% | 0.5525 | F | RR | 0.90 [0.73, 1.11] | -1.00 | 0.3171 | – |
| Donor age at KT (year) | 15 | 1956 | 34.70% | 0.0910 | F | MD | -2.19 [-3.46, -0.93] | -3.40 | 0.0007 | 0.4067 |
| Donor age at KT (per year) | 3 | 389 | 0.00% | 0.4354 | F | RR | 0.99 [0.97, 1.01] | -0.79 | 0.4314 | – |
| Living donor | 26 | 4472 | 48.80% | 0.0029 | F | RR | 1.02 [0.90, 1.14] | 0.28 | 0.7781 | 0.0003 |
| Related donor | 21 | 2559 | 62.90% | < 0.0001 | R | RR | 1.53 [1.24, 1.88] | 4.02 | < 0.0001 | 0.0001 |
| Living related donor (vs. living unrelated donor) | 10 | 1221 | 21.40% | 0.2461 | F | RR | 1.69 [1.31, 2.18] | 3.99 | < 0.0001 | 0.1001 |
| Primary disease | ||||||||||
| Age at IgAN diagnosis (year) | 6 | 909 | 71.70% | 0.0034 | R | MD | -2.52 [-6.73, 1.69] | -1.17 | 0.2412 | – |
| Age at IgAN diagnosis (per year) | 2 | 417 | 86.00% | 0.0075 | R | RR | 0.99 [0.93, 1.05] | -0.43 | 0.6699 | – |
| Time from IgAN diagnosis to ESRD (year) | 13 | 1448 | 0.00% | 0.6548 | F | MD | -1.84 [-2.43, -1.25] | -6.14 | < 0.0001 | 0.8399 |
| Time from IgAN diagnosis to ESRD (per year) | 3 | 293 | 0.00% | 0.4097 | F | RR | 0.94 [0.91, 0.97] | -3.41 | 0.0007 | – |
| History of KT | ||||||||||
| History of KT | 12 | 4421 | 47.40% | 0.0342 | F | RR | 1.43 [1.24, 1.65] | 4.98 | < 0.0001 | 0.5062 |
| Dialysis history | ||||||||||
| Time on dialysis (month) | 19 | 2164 | 44.60% | 0.0193 | F | MD | -3.14 [-4.18, -2.09] | -5.88 | < 0.0001 | 0.5114 |
| Hemodialysis | 3 | 689 | 1.70% | 0.3615 | F | RR | 1.68 [1.04, 2.71] | 2.13 | 0.0331 | – |
| Pre-emptive transplant | 10 | 1569 | 52.70% | 0.0249 | R | RR | 1.12 [0.77, 1.62] | 0.60 | 0.5501 | 0.5854 |
| Comorbidities | – | |||||||||
| Hypertension | 7 | 600 | 44.80% | 0.0923 | F | RR | 1.09 [0.76, 1.57] | 0.49 | 0.6245 | – |
| Diabetes | 3 | 276 | 0.00% | 0.6065 | F | RR | 1.22 [0.73, 2.03] | 0.75 | 0.4547 | – |
| Histocompatibility | ||||||||||
| Panel reactive antibodies | 4 | 689 | 65.90% | 0.0320 | R | MD | 0.95 [-3.55, 5.45] | 0.41 | 0.6795 | – |
| Panel reactive antibodies >50% | 3 | 543 | 0.00% | 0.5899 | F | RR | 0.66 [0.34, 1.29] | -1.21 | 0.2259 | – |
| Pretransplant donor specific antibody | 5 | 1267 | 67.70% | 0.0148 | R | RR | 1.01 [0.53, 1.94] | 0.04 | 0.9650 | – |
| ABO-incompatibility | 4 | 505 | 0.00% | 0.8607 | F | RR | 0.89 [0.60, 1.31] | -0.60 | 0.5487 | – |
| HLA-A/B/DR mismatches | 19 | 2414 | 38.40% | 0.0455 | F | MD | -0.11 [-0.22, -0.00] | -2.00 | 0.0455 | 0.6727 |
| HLA-A/B mismatches | 2 | 251 | 0.00% | 0.7481 | F | MD | 0.09 [-0.05, 0.22] | 1.20 | 0.2294 | – |
| HLA-DR mismatches | 2 | 251 | 0.00% | 0.7494 | F | MD | -0.13 [-0.22, -0.05] | -3.00 | 0.0027 | – |
| HLA-A/B/DR full match | 4 | 905 | 31.3% | 0.2244 | F | RR | 1.88 [1.14, 3.11] | 2.47 | 0.0135 | – |
| HLA-A full match | 2 | 98 | 0.00% | 0.8560 | F | RR | 1.48 [0.70, 3.09] | 1.03 | 0.3021 | – |
| HLA-B full match | 4 | 180 | 36.70% | 0.1921 | F | RR | 1.12 [0.72, 1.76] | 0.51 | 0.6084 | – |
| HLA-DR full match | 4 | 229 | 85.80% | < 0.0001 | R | RR | 0.71 [0.15, 3.38] | -0.43 | 0.6693 | – |
| HLA identied related donor (vs. other) | 2 | 152 | 78.70% | 0.0301 | R | RR | 2.91 [0.7, 12.01] | 1.47 | 0.1406 | – |
| HLA identied related donor (vs. not identied related donor) | 3 | 92 | 18.50% | 0.2932 | F | RR | 1.14 [0.70, 1.88] | 0.53 | 0.5964 | – |
| HLA-A2 | 7 | 661 | 36.90% | 0.1471 | F | RR | 1.03 [0.78, 1.37] | 0.21 | 0.8300 | – |
| HLA-B35 | 8 | 1051 | 0.00% | 0.7456 | F | RR | 1.25 [0.95, 1.64] | 1.59 | 0.1116 | – |
| HLA-B46 | 3 | 290 | 0.00% | 0.5821 | F | RR | 0.39 [0.16, 0.95] | -2.06 | 0.0392 | – |
| HLA-DR3 | 2 | 466 | 0.00% | 0.9142 | F | RR | 1.14 [0.84, 1.55] | 0.86 | 0.3883 | – |
| HLA-DR4 | 4 | 397 | 82.80% | 0.0006 | R | RR | 2.91 [0.94, 8.97] | 1.86 | 0.0630 | – |
| Induction therapy | ||||||||||
| None | 9 | 1453 | 70.50% | 0.0007 | R | RR | 1.73 [1.16, 2.58] | 2.69 | 0.0071 | – |
| Anti-IL-2-R antibodies | 14 | 2102 | 79.80% | < 0.0001 | R | RR | 0.68 [0.47, 0.99] | -2.02 | 0.0429 | 0.8046 |
| Antithymocyte globulin | 13 | 1844 | 74.10% | < 0.0001 | R | RR | 0.97 [0.64, 1.47] | -0.15 | 0.8784 | 0.0189 |
| Anti-CD20 antibodies | 2 | 312 | 74.20% | 0.0488 | R | RR | 0.63 [0.22, 1.82] | -0.85 | 0.3951 | – |
| Maintenance therapy | ||||||||||
| Tacrolimus | 16 | 2146 | 52.20% | 0.0077 | R | RR | 0.90 [0.68, 1.19] | -0.72 | 0.4741 | 0.5163 |
| Cyclosporine | 15 | 1701 | 41.90% | 0.0445 | F | RR | 1.07 [0.90, 1.28] | 0.77 | 0.4414 | 0.2776 |
| MMF | 12 | 1846 | 24.90% | 0.1996 | F | RR | 0.69 [0.56, 0.86] | -3.28 | 0.0010 | 0.9129 |
| Azathioprine | 6 | 684 | 2.00% | 0.4036 | F | RR | 1.18 [0.85, 1.64] | 0.99 | 0.3239 | – |
| mTOR inhibitor | 7 | 602 | 0.00% | 0.5686 | F | RR | 1.51 [1.10, 2.06] | 2.57 | 0.0102 | – |
| Steroids | 10 | 3504 | 74.1% | < 0.0001 | R | RR | 0.88 [0.56, 1.38] | -0.55 | 0.5831 | 0.3347 |
| Graft rejection | ||||||||||
| Rejection | 8 | 1305 | 36.00% | 0.1414 | F | RR | 1.10 [0.83, 1.46] | 0.69 | 0.4932 | – |
| T cell-mediated rejection | 2 | 361 | 34.80% | 0.2155 | F | RR | 1.42 [0.96, 2.09] | 1.75 | 0.0800 | – |
| Antibody-mediated rejection | 3 | 374 | 0.00% | 0.9932 | F | RR | 0.85 [0.52, 1.38] | -0.67 | 0.5042 | – |
| Acute rejection | 13 | 2063 | 0.00% | 0.6052 | F | RR | 1.13 [0.96, 1.34] | 1.43 | 0.1532 | 0.9843 |
| Acute T cell-mediated rejection | 2 | 754 | 0.00% | 0.6059 | F | RR | 1.39 [0.99, 1.94] | 1.92 | 0.0547 | – |
| Acute antibody-mediated rejection | 2 | 754 | 81.70% | 0.0195 | R | RR | 1.25 [0.35, 4.47] | 0.35 | 0.7279 | – |
| Chronic rejection | 3 | 468 | 28.60% | 0.2465 | F | RR | 1.33 [0.91, 1.93] | 1.47 | 0.1403 | – |
| Other therapy | ||||||||||
| ACEI/ARB | 8 | 640 | 0.00% | 0.6797 | F | RR | 1.80 [1.42, 2.28] | 4.87 | < 0.0001 | – |
| Plasma exchange | 2 | 312 | 0.00% | 0.4185 | F | RR | 0.80 [0.54, 1.18] | -1.12 | 0.2639 | – |
| Tonsillectomy | 2 | 350 | 0.00% | 0.6420 | F | RR | 0.43 [0.23, 0.79] | -2.69 | 0.0072 | – |
| Steroids use before KT | 2 | 173 | 0.00% | 0.3936 | F | RR | 0.97 [0.58, 1.62] | -0.13 | 0.8995 | – |
| Immunosuppression use before KT | 3 | 279 | 62.00% | 0.0718 | R | RR | 1.27 [0.60, 2.71] | 0.62 | 0.5363 | – |
| Other | ||||||||||
| Cold ischemia time (hour) | 7 | 1356 | 12.90% | 0.3312 | F | MD | 0.10 [-0.76, 0.96] | 0.23 | 0.8188 | – |
| Delayed graft function | 5 | 443 | 18.60% | 0.2960 | F | RR | 0.70 [0.43, 1.12] | -1.48 | 0.1377 | – |
| Cytomegalovirus infection | 2 | 476 | 0.00% | 0.8245 | F | RR | 0.79 [0.45, 1.38] | -0.84 | 0.4023 | – |
| BK virus infection | 2 | 517 | 0.00% | 0.5896 | F | RR | 1.32 [0.67, 2.57] | 0.81 | 0.4205 | – |
| Outcomes | ||||||||||
| Graft loss | 30 | 5986 | 82.80% | < 0.0001 | R | RR | 2.19 [1.60, 3.01] | 4.88 | < 0.0001 | 0.0040 |
| Death | 4 | 703 | 0.00% | 0.5712 | F | RR | 0.77 [0.42, 1.41] | -0.85 | 0.3952 | – |
| Infection | 2 | 339 | 0.00% | 0.8135 | F | RR | 1.02 [0.66, 1.59] | 0.10 | 0.9231 | – |
IgAN, immunoglobulin A nephropathy; ES, effect size; CI, confidence interval; KT, kidney transplantation; R, random effects model; F, fixed effect model; MD, mean difference; RR, risk ratio; ESRD, end stage renal disease; HLA, human leukocyte antigen; MMF, mycophenolate mofetil; ACEI, angiotensin-converting enzyme inhibitors; ARB, angiotensin receptor blockers.