# Donor Risk Factors Affecting Graft Survival in Pediatric Kidney Transplants: Protocol for a Systematic Review and Meta-Analysis

## TL;DR

This study will review how donor factors affect the success of kidney transplants in children, aiming to guide better clinical decisions and improve outcomes.

## Contribution

The study provides an updated systematic review and meta-analysis of donor-related risk factors for graft survival in pediatric kidney transplants.

## Key findings

- The review will synthesize evidence on donor factors like age, size, comorbidities, and ethnicity affecting graft survival in pediatric kidney transplants.
- Subgroup analyses will compare living and deceased donor impacts on graft outcomes.
- Findings will support clinical decision-making and policy development for pediatric kidney transplant recipients.

## Abstract

Pediatric patients with end-stage kidney disease require kidney transplants (KTs) throughout their lifetime. Long-term graft survival is dependent on multiple factors, which are broadly categorized as donor- and recipient-related factors. Advances in transplant care and changes in donor population demographics necessitate an updated analysis on donor risk factors to guide clinical decision-making.

In this systematic review and meta-analysis, we will focus on the impact of donor factors on graft survival in pediatric KT, excluding transplants from donation after circulatory death as the latter are less common in children.

This review encompasses studies reporting donor-related risk factors for graft survival in pediatric KT, including age, size, comorbidities, and ethnicity for living and deceased donors, as well as the cause of death and length of hospitalization for deceased donors. The literature search will use the following databases: PubMed, Scopus, Web of Science, Embase, and Cochrane. Two independent reviewers will select studies and assess their quality. Pooled estimates of relevant factors will be computed via a random-effects model using the Stata/BE (version 19) software. Depending on data availability, subgroup analyses will be conducted based on donor type (living vs deceased). The reporting of findings will adhere to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

The search and screening for the systematic literature review are anticipated to be finished in June 2026. Data extraction, quality appraisal, and subsequent data synthesis will begin in July 2026. The review is expected to be completed by October 2026, and the study results will be published in 2027.

Our review will provide a comprehensive synthesis of the available evidence on kidney donor risk factors impacting graft survival in pediatric KT. The results of this review could provide valuable insights for clinical decisions, policy development, and ongoing efforts to improve outcomes for children with end-stage kidney disease requiring KT.