Interventions to Improve Life Participation in Kidney Transplant Recipients: A Systematic Review

Rationale & Objective: Life participation, defined as the ability to participate in meaningful activities of daily living, is a critically important outcome for kidney transplant recipients. We aimed to evaluate the effectiveness of any interventions on life participation in kidney transplant recipients. 

Study Design: A systematic review of randomized controlled studies. 

Study Populations: Adult kidney transplant recipients. 

Search Strategy & Sources: MEDLINE, Embase, CENTRAL, PsycINFO and CINAHL were searched up to March 2023. 

Data Extraction: Two authors independently screened titles and abstracts, and extracted data from the included studies using standard data extraction forms. 

Analytical Approach: We used random-effects models with relative risk for dichotomous outcomes and mean difference for continuous outcomes with 95% confidence intervals (CIs). Confidence in the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. 

Results: From 14,162 reports, only 33 studies (4,857 participants) were included. The risk of bias was adjudicated as high or unclear for most domains. No studies reported the outcome of life participation specifically. Among 33 studies, mental, physical and social functioning were reported in 5 (15%), 5 (15%), and 11 (33%) studies, respectively. 

Limitations: A wide range of interventions were included across the studies with a limited follow-up, and we were unable to pool the data and perform meta-analysis for outcomes that were reported in a single study only or in studies reporting no events. 

Conclusions: The effects of prebiotics, erythropoietin-stimulating agents, immunosuppressive treatments, induction therapy of interleukin-2 receptor antagonist, exercise, nutrition, education, and surgical procedures on life participation-related outcomes were uncertain. Life participation was not reported as a specific outcome in trials in kidney transplant recipients with very limited evidence on interventions for life participation-related outcomes. Trial-based evidence for interventions to improve life participation, a critical outcome for kidney transplant recipients, is needed.