Review Article

Graft and Patient Survival Rate among Iranian Pediatric Recipients of Kidney Transplantation: A Systematic Review and Meta-Analysis


Background: The End Stage Renal Disease (ESRD) is irreversible impairment of renal function, to the extent that the patient becomes permanently dependent on alternative therapies, especially in children. We aimed to evaluate the graft and patient survival rate among iranian pediatric recipients of kidney transplantation through a systematic review and meta-analysis.

Methods: National (SID, MagIran, IranMedex, IranDoc) and international (Cochrane, Embase, ScienceDirect, Scopus, PubMed, and Web of Science) databases of, were searched to find studies published electronically from 1985 until Nov 2019. Heterogeneity between the collected studies was determined using the Cochran’s test (Q) and I2. Meta-regression was used to investigate the factors affecting statistical heterogeneity in 1, 5, and 10-year survival of kidney transplantation in addition to subgroup analysis based on cities.

Results: Ten studies were qualified to enter the meta-analysis. The total participants in the study were 2673 people with an average age of 13.71±3.65 years. In the random-effects model, the survival rate of 1, 3, 5 and 10 yr of kidney transplantation were 91, 88, 81 and 70%, respectively.

Conclusion: By providing the documented and comprehensive evidence, can be the basis of many plans, policies, and decisions of various sectors of development. These sectors include the evaluation of treatment programs and health interventions in the pediatric kidney transplantation. The results of the present study can provide an acceptable estimate of the survival rate of transplanted children in Iran and will be useful for planning prevention and treatment programs.

1. Ghelichi Ghojogh M, Taghizadeh Afshari A, Salarilak S, et al (2017). The Effect of Body Mass Index on Patient and Graft Survival Rate in Kidney Transplanted Patients in Iran. Nephro-Urol Mon, 9(4): e14386.
2. Ghelichi-Ghojogh M, Ghaem H, Mohammadizadeh F, et al (2021). Graft and Patient Survival Rates in Kidney Transplantation, and Their Associated Factors: A Systematic Review and Meta-Analysis. Iran J Public Health, 50(8):1555-1563.
3. Naderi G, Latif A, Karimi S, et al (2017). The long-term outcome of pediatric kidney transplantation in Iran: Results of a 25-year single-center cohort study. Int J Organ Transplant Med, 8(2):85-96
4. Gheissari A, Hemmatzadeh S, Merrikhi A, et al (2012). Chronic kidney disease in children: A report from a tertiary care center over 11 years. J Nephropathol, 1(3):177-82.
5. Einollahi B, Pourfarziani V, Ahmadzad-Asl M, et al (2007). Iranian model of renal allograft transplantation in 3028 recipients: survival and risk factors. Transplant Proc, 39(4):907-10.
6. Hariharan S, Johnson CP, Bresnahan BA, et al (2000). Improved graft survival after renal transplantation in the United States, 1988 to 1996. N Engl J Med, 342(9):605-12.
7. Salehipour M, Bahador A, Jalaeian H, et al (2008). Comparison of right and left grafts in renal transplantation. Saudi J Kidney Dis Transpl, 19(2):222-6.
8. Simforoosh N, Basiri A, Fattahi M, et al (2006). Living unrelated versus living related kidney transplantation: 20 years’ experience with 2155 cases. Transplant Proc, 38(2):422-5.
9. van Walraven C, Austin PC, Knoll G (2010). Predicting potential survival benefit of renal transplantation in patients with chronic kidney disease. CMAJ, 182(7):666-72.
10. Wong G, Howard K, Chapman JR, et al (2012). Comparative survival and economic benefits of deceased donor kidney transplantation and dialysis in people with varying ages and co-morbidities. PLoS One, 7(1):e29591.
11. Georgieva S, Mitov K, Dimitrova M, et al (2012). Survival on pharmacotherapy analysis for patients after kidney transplantation. Int J Pharmaceutical Sci Rev Res, 16(2):30-4.
12. Ghojogh MG, Salarilak S, Afshari AT, et al (2018). Impact of type of donor on graft and patient survival rate in kidney transplanted patients in Iran. J Renal Inj Prev, 7(4):264-8.
13. Heldal K, Hartmann A, Grootendorst DC, et al (2010). Benefit of kidney transplantation beyond 70 years of age. Nephrol Dial Transplant, 25(5):1680-7.
14. Nathan HM, Conrad SL, Held PJ, et al (2003). Organ donation in the United States. Am J Transplant, 3 Suppl 4:29-40.
15. Tekin S, Yavuz H, Yuksel Y, et al (2015). Kidney transplantation from elderly donor. Transplant Proc, 47(5):1309-11.
16. Gholamrezaie HR, Tabibi A, Nikravesh N, et al (2020). Results of Pediatric Kidney Transplants in an 8-Year Period: A Retrospective Study. Transplant Proc, 52(3):793-99.
17. Williams RC, West LJ, Opelz G (2018). The risk of failure with HLA mismatch and recipient age in first pediatric (< 18 years) kidney transplants. Transplant Direct, 4(7): e365.
18. Starzl T, Groth C, Putnam C, et al (1970). Urological complications in 216 human recipients of renal transplants. Ann Surg, 172(1):1-22.
19. Dharnidharka VR, Fiorina P, Harmon WE (2014). Kidney transplantation in children. N Engl J Med, 371(6):549-58.
20. Van Arendonk KJ, Boyarsky BJ, Orandi BJ, et al (2014). National trends over 25 years in pediatric kidney transplant outcomes. Pediatrics, 133(4):594-601.
21. Assadi F (2013). Pediatric Kidney Transplantation Kids are Different. Iran J Kidney Dis. 7(6):429-31.
22. Torkaman M, Khalili-Matin-Zadeh Z, Azizabadi-Farahani M, et al (2007). Outcome of living kidney transplant: pediatric in comparison to adults. Transplant Proc, 39(4):1088-90.
23. Sert I, Yavascan Ö, Tugmen C, et al (2013). A retrospective analysis of long-term graft survival in 61 pediatric renal transplant recipients: a single-center experience. Ann Transplant, 18:497-504.
24. de Weerd AE, Betjes MG (2018). ABO-incompatible kidney transplant outcomes: a meta-analysis. Clin J Am Soc Nephrol, 13(8):1234-43.
25. Munn Z, Moola S, Lisy K, et al (2015). Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data. Int J Evid Based Healthc, 13(3):147-53.
26. Fadel FI, Bazaraa HM, Badawy H, et al (2020). Pediatric kidney transplantation in Egypt: Results of 10‐year single‐center experience. Pediatr Transplant, 24(6):e13724.
27. Friedersdorff F, Koch T-M, Banuelos-Marco B, et al (2018). Long-Term follow-up after paediatric kidney transplantation and influence factors on graft survival: a single-centre experience of 16 years. Uro Int, 100(3):317-21.
28. North American Pediatric Renal Trials and Collaborative Studies. 2010 Annual transplant report. Available from:
29. Aoki Y, Hamasaki Y, Satoh H, et al (2020). Long‐term outcomes of pediatric kidney transplantation: A single‐center experience over the past 34 years in Japan. Int J Urol, 27(2):172-8.
30. Bijalwan P, Sanjeevan KV, Mathew A, et al (2017). Outcome and complications of living donor pediatric renal transplantation: Experience from a tertiary care center. Indian J Urol, 33(3):221-225.
31. Haberal M, Bereket G, Karakayalı H, et al (2000). Pediatric renal transplantation in Turkey: a review of 56 cases from a single center. Ped Transplant, 4(4):293-9.
32. Papachristou F, Stabouli S, Printza N et al (2016). Long‐term outcome of pediatric kidney transplantation: A single‐center experience from Greece. Pediatr Transplant, 20(4):500-6.
33. Sushkov AI, Molchanova EA, Kaabak MM, et al (2019). Pediatric kidney transplantation: early and long-term outcomes following 1187 procedures. Khirurgiia, 1:14-26.
34. Sigurjonsdottir VK, Grimm PC (2019). Living or deceased donor kidney transplantation in children. Curr Opin Pediatr, 31(2):232-6.
35. Mehrabi A, Golriz M, Khajeh E, et al (2019). Surgical outcomes after pediatric kidney transplantation at the University of Heidelberg. J Pediatr Urol, 15(3): 221.e1-221.e8.
36. Francis A, Johnson DW, Melk A, et al (2020). Survival after kidney transplantation during childhood and adolescence. Clin J Am Soc Nephrol, 15(3):392-400.
37. Canning DA (2017). Re: Gordon A. Mclorie. May 2, 1945-February 2, 2015. J Urol, 197(5):1355-7.
38. Smith JM, Martz K, Blydt‐Hansen TD (2013). Pediatric kidney transplant practice patterns and outcome benchmarks, 1987–2010: A report of the N orth A merican P ediatric R enal T rials and C ollaborative S tudies. Pediatr Transplant, 17(2):149-57.
39. Gander R, Asensio M, Royo GF, et al (2017). Treatment of post-transplant lymphocele in children. Urology, 103:218-23.
40. Hashemi GH, Malek Hosseini SA, Fallah-Zadeh MH, et al (1996). Kidney transplantation in children and adolescents of Southern Iran. Med J Islam Repub Iran, 10(1):7-9.
41. Khammar MA, Mahdavi-Zafarghandi R (2001). Renal transplantation in children: results of 9 years of renal transplantation in children at our center. Transplant Proc, 33(5):2825.
42. Mahdavi R, Naghib M (2002). Kidney transplantation in children: results of ten years exp erience in imam reza hospital. Med J Islam Repub Iran, 16(3):145-9.
43. Otukesh H, Basiri A, Simfrosh N, et al (2006). Outcome of pediatric renal transplantation in Labfi Nejad Hospital, Tehran, Iran. Pediatr Nephrol, 21(10):1459-63.
44. Otukesh H, Basiri A, Simfroosh N, et al (2008). Kidney transplantation in children with posterior urethral valves. Pediatr Transplant, 12(5):516-9.
45. Otukesh H, Hoseini R, Rahimzadeh N, et al (2011). Outcome of renal transplantation in children: A multi‐center national report from Iran. Pediatr Transplant, 15(5):533-8.
46. Almasi-Hashiani A, Rajaeefard A, Hassanzade J, et al (2012). Graft survival rate in pediatric renal transplantation: A single center experience. Pak J Med Sci, 28(5):806-11.
47. Hoseini R, Mirzaiee N, Rahimzadeh N (2015). Renal transplantation outcome in children with cystinosis. Int J Child Adoles, 1(2):10-2.
IssueVol 51 No 6 (2022) QRcode
SectionReview Article(s)
Kidney Transplantation End stage renal disease Graft survival Patient survival Meta-analysis

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How to Cite
Shajari A, Ashrafi M, Shajari H, Derakhshan A. Graft and Patient Survival Rate among Iranian Pediatric Recipients of Kidney Transplantation: A Systematic Review and Meta-Analysis. Iran J Public Health. 2022;51(6):1232-1244.