Early surgical complications following kidney transplantation in adults: A systematic review

To quantify and characterise short-term (<90 days) surgical complications following kidney transplantation and identify risk factors for complications.

This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the protocol registered with PROSPERO (ID CRD42024535328). Studies reporting surgical and postoperative complications within 90 days of surgery were included as well as studies reporting on groups of complications such as urological, vascular or wound related. The quality of evidence was assessed using the Newcastle-Ottawa Scale (NOS) and number of fulfilled Martin criteria.

Of 1654 articles screened, 30 were included. In studies reporting on complications within 30 days of surgery the weighted overall complication rate was 41 % (range 13-70 %), the weighted reoperation rate was 13 % (range 9.8-17 %) and the weighted rate of major complications was 19 % (range 7.6-24 %). In studies reporting on complications within 90 days of surgery the weighted overall complication rate was 36 % (range 12-60 %), the weighted reoperation rate was 17 % (range 5.0-23 %) and the weighted rate of major complications was 24 % (range 19-25 %). Studies were heterogenous and the quality was rated poor to good according to the NOS and fulfilling a median of 7 Martin criteria (range 4-9). Possible risk factors for complications included high BMI, recipient age and sex.

Kidney transplantation remains a high-risk surgical procedure. We identified considerable variation in how complications were reported, limiting comparison of outcomes between centres as well as the potential impact of peri-operative interventions to improve surgical outcomes.