Summary of findings for the main comparison.
Hypothermic machine perfusion versus static cold storage for deceased donor kidney transplantation
| Hypothermic machine perfusion versus static cold storage for deceased donor kidney transplantation | ||||||
| Patient or population: deceased donor kidney transplantation Intervention: hypothermic machine perfusion Comparison: static cold storage | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with static cold storage | Risk with hypothermic machine perfusion | |||||
| DGF | 409 per 1,000 | 315 per 1,000 (274 to 368) | RR 0.77 (0.67 to 0.90) | 2138 (14) | ⊕⊕⊕⊕ HIGH | ‐ |
| DGF: DCD group | 501 per 1,000 | 376 per 1,000 (321 to 436) | RR 0.75 (0.64 to 0.87) | 772 (7) | ⊕⊕⊕⊕ HIGH | ‐ |
| DGF: DBD group | 342 per 1,000 | 266 per 1,000 (222 to 318) | RR 0.78 (0.65 to 0.93) | 971 (4) | ⊕⊕⊕⊕ HIGH | ‐ |
| DGF: modern era studies | 372 per 1,000 | 286 per 1,000 (245 to 338) | RR 0.77 (0.66 to 0.91) | 1355 (5) | ⊕⊕⊕⊕ HIGH | ‐ |
| DGF: pre‐2008 studies | 474 per 1,000 | 370 per 1,000 (289 to 470) | RR 0.78 (0.61 to 0.99) | 783 (9) | ⊕⊕⊕⊕ HIGH | ‐ |
| One year graft survival | See comments | See comments | ‐ | ‐ | ‐ | Meta‐analysis was not possible. There is strong evidence of improved graft survival with HMP |
| PNF | 65 per 1,000 | 57 per 1,000 (38 to 86) | RR 0.88 (0.58 to 1.33) | 1387 (7) | ⊕⊕⊕⊕ HIGH | ‐ |
| Duration of DGF | The mean duration of DGF was 11.8 days | Mean duration of DGF was 1.23 fewer days (5.87 fewer to 3.4 more) | ‐ | 220 (4) | ⊕⊝⊝⊝ VERY LOW 1 | ‐ |
| One year patient survival | 965 per 1,000 | 955 per 1,000 (917 to 994) | RR 0.99 (0.95 to 1.03) | 920 (3) | ⊕⊕⊝⊝ LOW 2 | ‐ |
| Treated acute rejection in the first year | 244 per 1,000 | 161 per 1,000 (90 to 285) | RR 0.66 (0.37 to 1.17) | 248 (2) | ⊕⊕⊝⊝ LOW 3 | ‐ |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; DBD: donor after brainstem death; DCD: donor after circulatory death; DGF: delayed graft function; MD: mean difference; PNF: primary non‐function; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1 Downgraded three levels: not all studies reporting DGF duration could be included in the meta‐analysis and high level of heterogeneity between studies
2 Downgraded two levels: not all studies reporting patient survival duration could be included in the meta‐analysis, and none of the studies were powered to allow analysis of patient survival
3 Downgraded two levels: reporting at different time points prevented inclusion of several studies into meta‐analysis. In addition different studies used different definitions for acute rejection, some being dependent on biopsies and some on clinical judgement.