Meta-Analysis
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Feb 24, 2017; 7(1): 81-87
Published online Feb 24, 2017. doi: 10.5500/wjt.v7.i1.81
Contrast-induced acute kidney injury in kidney transplant recipients: A systematic review and meta-analysis
Wisit Cheungpasitporn, Charat Thongprayoon, Michael A Mao, Shennen A Mao, Matthew R D'Costa, Wonngarm Kittanamongkolchai, Kianoush B Kashani
Wisit Cheungpasitporn, Charat Thongprayoon, Michael A Mao, Shennen A Mao, Matthew R D'Costa, Wonngarm Kittanamongkolchai, Kianoush B Kashani, Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MI 55905, United States
Author contributions: Cheungpasitporn W and Thongprayoon C contributed equally to this work; Cheungpasitporn W and Thongprayoon C performed the search, analysis, and interpretation of data, analysis of data, and final approval of the version to be published; Mao MA, Mao SA, D’Costa MR and Kittanamongkolchai W performed critical revising of the intellectual content and final approval of the version to be published; Kashani KB performed concept and design, critical revising of the intellectual content, and final approval of the version to be published.
Conflict-of-interest statement: All authors report no conflicts-of-interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kianoush B Kashani, MD, Assistant Professor, Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MI 55905, United States. kashani.kianoush@mayo.edu
Telephone: +1-507-2667093 Fax: +1-507-2667891
Received: August 25, 2016
Peer-review started: August 26, 2016
First decision: September 27, 2016
Revised: November 12, 2016
Accepted: December 27, 2016
Article in press: December 29, 2016
Published online: February 24, 2017
Abstract
AIM

To evaluate the incidence of contrast-induced acute kidney injury (CIAKI) in kidney transplant recipients.

METHODS

A literature search was performed using MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews from the inception of the databases through July 2016. Studies assessing the incidence of CIAKI in kidney transplant recipients were included. We applied a random-effects model to estimate the incidence of CIAKI.

RESULTS

Six studies of 431 kidney transplant recipients were included in the analyses to assess the incidence of CIAKI in kidney transplant recipients. The estimated incidence of CIAKI and CIAKI-requiring dialysis were 9.6% (95%CI: 4.5%-16.3%) and 0.4% (95%CI: 0.0%-1.2%), respectively. A sensitivity analysis limited only to the studies that used low-osmolar or iso-osmolar contrast showed the estimated incidence of CIAKI was 8.0% (95%CI: 3.5%-14.2%). The estimated incidences of CIAKI in recipients who received contrast media with cardiac catheterization, other types of angiogram, and CT scan were 16.1% (95%CI: 6.6%-28.4%), 10.1% (95%CI: 4.2%-18.0%), and 6.1% (95%CI: 1.8%-12.4%), respectively. No graft losses were reported within 30 d post-contrast media administration. However, data on the effects of CIAKI on long-term graft function were limited.

CONCLUSION

The estimated incidence of CIAKI in kidney transplant recipients is 9.6%. The risk stratification should be considered based on allograft function, indication, and type of procedure.

Keywords: Acute kidney injury, Kidney transplantation, Contrast-induced nephropathy, Contrast-induced acute kidney injury, Transplantation

Core tip: We conducted this meta-analysis to assess the incidence of contrast-induced acute kidney injury (CIAKI) in kidney transplant recipients. The estimated incidence of CIAKI is 9.6%. The estimated incidence of CIAKI in recipients who received contrast media is highest at 16% with cardiac catheterization, followed by 10% with other types of angiogram, and 6% with computed tomography scan. The findings from this study may impact the risk stratification for administration of contrast media and CIAKI prevention in kidney transplant recipients.