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Prophylactic antithrombotic management in adult and pediatric kidney transplantation: A systematic review and meta‐analysis
Author(s) -
Bapistella Sascha,
Zirngibl Matthias,
Buder Kathrin,
Toulany Nikan,
Laube Guido F.,
Weitz Marcus
Publication year - 2021
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.14021
Subject(s) - medicine , systematic review , meta analysis , medline , adverse effect , randomized controlled trial , dosing , intensive care medicine , relative risk , confidence interval , pediatrics , political science , law
Background RGT is a major cause for early graft loss after KTx. Although evidence‐based recommendations are lacking, aP is often used to prevent RGT. This systematic review aimed to determine the effectiveness and safety of aP in adult and pediatric KTx recipients. Methods MEDLINE, EMBASE, Cochrane Controlled Trials Register, conference proceedings, and electronic databases for trial registries were searched for eligible studies using search terms relevant to this review (April 21, 2020). The systematic review was carried out following the recommendations of the Cochrane Collaboration and the Prefered Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) Statement. Results Twelve studies comprising 2370 patients (adult = 1415, pediatric = 955) were included, of which three were RCTs. The overall risk for developing RGT was lower in the group with aP compared with the control group (RR 0.24, 95% confidence interval 0.12–0.49). The antithrombotic drugs used were heparin (7/12), acetylsalicylic acid (2/12), a combination of both (2/12), and dipyridamole (1/12) with a high variability in timing, dosing, and mode of application. Adverse effects were reported rarely, with minor bleeding as the main complication. The non‐randomized studies had significant risks of bias in the domains of patient selection, confounder, and measurement of outcomes. Conclusion Based on pooled analysis, aP seems to reduce the risk of RGT in KTx. However, the reliability of these results is limited, as the quality of the available studies is poor and information on adverse effects associated with aP is scarce. Additional high‐quality research is urgently needed to provide sufficient data supporting the use of aP in KTx.