Interventions to improve life participation in kidney transplant recipients: a systematic review and meta-analysis

Background: Life participation, defined as the ability to participate in meaningful activities of daily living is a critically important outcome for kidney transplant recipients. The aim of this systematic review was to evaluate the effectiveness of interventions on life participation in kidney transplant recipients. Methods: MEDLINE, Embase, CENTRAL, PsycINFO and CINAHL were searched to March 2023. Randomized controlled trials evaluating the effects of any interventions on life participation (including broader constructs such as quality of life that included a subscale or item for life participation, or similar concepts such as physical functioning) in adult kidney transplant recipients were eligible. Two authors independently extracted data. We used random effects models with relative risk (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes with 95% confidence interval (CI). Confidence in the evidence was assessed using GRADE. Results: Thirty-three studies (4857 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. Fourteen (42.4%) studies included a broad (quality of life) measure that included a susbscale or item for life participation. Mental functioning, physical functioning and social functioning were reported in five (15%), five (15%), and eleven (33%) studies, respectively. The effects of prebiotics, erythropoietin stimulating agents, immunosuppressive treatments, interleukins, exercise, nutrition, education, and surgical procedures on life participation or life participation-related outcomes were uncertain. Conclusion: Life participation was not reported as a specific outcome in randomized 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 in kidney transplant recipients is needed.