{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T01:07:15Z","timestamp":1778029635428,"version":"3.51.4"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2025,7,12]],"date-time":"2025-07-12T00:00:00Z","timestamp":1752278400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Emerging evidence suggests that ambient air pollution may adversely affect long-term outcomes in kidney transplant recipients; however, quantitative estimates across clinical endpoints remain limited. This meta-analysis aimed to systematically evaluate the association between air pollution exposure and mortality, graft failure, and rejection risk in kidney transplant populations.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A systematic database search was carried out across the databases of the Cochrane Library, Web of Science, Scopus, and PubMed until the 1 May 2025. Research that evaluated the impact of air pollution, particularly PM\u2082.\u2085, PM\u2081\u2080, NO\u2082, O\u2083, and other ambient pollutants, on graft survival in kidney transplant recipients were evaluated. Hazard ratios (HR) were extracted or recalculated for all-cause mortality, death-censored graft failure, and graft rejection per 10\u00a0\u00b5g\/m\u00b3 increase in particulate matter concentration.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>After screening 6209 records, a total of six studies involving populations of adult kidney transplant recipients from the USA, UK, South Korea, and Taiwan were included in the meta-analysis. Exposure to ambient air pollution was significantly associated with increased all-cause mortality among kidney transplant recipients [pooled HR 1.61; 95% confidence intervals (CI) 1.01\u20132.58], as well as higher risks of death-censored graft failure (HR 1.25; 95% CI 1.04\u20131.50) and graft rejection (HR 1.35; 95% CI 1.09\u20131.69) per 10\u00a0\u00b5g\/m\u00b3 increment in particulate matter concentration. Substantial heterogeneity was observed across studies, particularly for mortality (I\u00b2 = 99%) and graft rejection (I\u00b2 = 91%). No significant associations were found between air pollution exposure and cardiovascular disease or coronary heart disease mortality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Ambient air pollution exposure is associated with increased risks of mortality, graft failure, and rejection in kidney transplant recipients, highlighting air pollution as a modifiable environmental risk factor that may have important implications for long-term transplant outcomes.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ckj\/sfaf222","type":"journal-article","created":{"date-parts":[[2025,7,12]],"date-time":"2025-07-12T12:49:50Z","timestamp":1752324590000},"source":"Crossref","is-referenced-by-count":4,"title":["Association between air pollution and transplant outcomes in kidney transplant recipients: a systematic review and meta-analysis"],"prefix":"10.1093","volume":"18","author":[{"given":"Mustafa","family":"Guldan","sequence":"first","affiliation":[{"name":"Koc University School of Medicine Department of Medicine, , Istanbul ,","place":["Turkey"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lasin","family":"Ozbek","sequence":"additional","affiliation":[{"name":"Koc University School of Medicine Department of Medicine, , Istanbul ,","place":["Turkey"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Derya Goksu","family":"Fidan","sequence":"additional","affiliation":[{"name":"Koc University School of Medicine Department of Medicine, , Istanbul ,","place":["Turkey"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ibrahim","family":"Gulmaliyev","sequence":"additional","affiliation":[{"name":"Koc University School of Medicine Department of Medicine, , Istanbul ,","place":["Turkey"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1297-0675","authenticated-orcid":false,"given":"Aladin","family":"Rustamov","sequence":"additional","affiliation":[{"name":"Koc University School of Medicine Department of Medicine, , Istanbul ,","place":["Turkey"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mehmet","family":"Kanbay","sequence":"additional","affiliation":[{"name":"Koc University School of Medicine Department of Medicine, Section of Nephrology, , Istanbul ,","place":["Turkey"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,7,12]]},"reference":[{"key":"2025081221072315300_bib1","doi-asserted-by":"publisher","first-page":"174796","DOI":"10.1016\/j.scitotenv.2024.174796","article-title":"Association of air pollution with incidence of end-stage kidney disease in two large European cohorts","volume":"948","author":"Cesaroni","year":"2024","journal-title":"Sci Total Environ"},{"key":"2025081221072315300_bib2","doi-asserted-by":"publisher","first-page":"1800","DOI":"10.1093\/ckj\/sfac101","article-title":"Increase in the global burden of chronic kidney disease: might it be attributable to air pollution?","volume":"15","author":"Copur","year":"2022","journal-title":"Clin Kidney J"},{"key":"2025081221072315300_bib3","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1093\/ckj\/sfy111","article-title":"Air pollution and kidney disease: review of current evidence","volume":"12","author":"Afsar","year":"2019","journal-title":"Clin Kidney J"},{"key":"2025081221072315300_bib4","doi-asserted-by":"publisher","first-page":"e096336","DOI":"10.1136\/bmjopen-2024-096336","article-title":"Air pollution-associated chronic kidney disease (APA-CKD): evidence from a cross-sectional study of Niger Delta communities","volume":"15","author":"Okoye","year":"2025","journal-title":"BMJ Open"},{"key":"2025081221072315300_bib5","doi-asserted-by":"crossref","first-page":"1515","DOI":"10.1016\/j.transproceed.2023.03.081","article-title":"Impact of particulate matter with an aerodynamic diameter &lt;2.5\u03bcm concentration on postoperative renal function in living kidney donors","volume":"55","author":"Moon","year":"2023","journal-title":"Transplant Proc"},{"key":"2025081221072315300_bib6","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1053\/j.ajkd.2020.02.447","article-title":"Particulate air pollution and progression to kidney failure with replacement therapy: an advanced CKD registry-based cohort study in Taiwan","volume":"76","author":"Lin","year":"2020","journal-title":"Am J Kidney Dis"},{"key":"2025081221072315300_bib7","doi-asserted-by":"publisher","first-page":"3333","DOI":"10.1111\/ajt.16605","article-title":"Ambient air pollution and posttransplant outcomes among kidney transplant recipients","volume":"21","author":"Feng","year":"2021","journal-title":"Am J Transplant"},{"key":"2025081221072315300_bib8","doi-asserted-by":"publisher","first-page":"107997","DOI":"10.1016\/j.envint.2023.107997","article-title":"Ambient black carbon reaches the kidneys","volume":"177","author":"Rasking","year":"2023","journal-title":"Environ Int"},{"key":"2025081221072315300_bib9","doi-asserted-by":"publisher","first-page":"e2128190","DOI":"10.1001\/jamanetworkopen.2021.28190","article-title":"Association of ambient fine particulate matter air pollution with kidney transplant outcomes","volume":"4","author":"Chang","year":"2021","journal-title":"JAMA Netw Open"},{"key":"2025081221072315300_bib10","doi-asserted-by":"publisher","first-page":"4297","DOI":"10.3390\/ijerph18084297","article-title":"Racial difference in the association of long-term exposure to fine particulate matter (PM(2.5)) and cardiovascular disease mortality among renal transplant recipients","volume":"18","author":"Dehom","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"2025081221072315300_bib11","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1186\/s12940-021-00827-7","article-title":"Adverse effects of fine particulate matter on human kidney functioning: a systematic review","volume":"21","author":"Rasking","year":"2022","journal-title":"Environ Health"},{"key":"2025081221072315300_bib12","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"2025081221072315300_bib13","doi-asserted-by":"publisher","first-page":"608","DOI":"10.1053\/j.ajkd.2011.05.017","article-title":"Ambient air pollutants and risk of fatal coronary heart disease among kidney transplant recipients","volume":"58","author":"Spencer-Hwang","year":"2011","journal-title":"Am J Kidney Dis"},{"key":"2025081221072315300_bib14","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1186\/s12940-021-00741-y","article-title":"Clinical outcomes associated with long-term exposure to airborne particulate pollution in kidney transplant recipients","volume":"20","author":"Kim","year":"2021","journal-title":"Environ Health"},{"key":"2025081221072315300_bib15","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.jth.2018.05.100","article-title":"Traffic-related air pollution and solid organ transplant failure in Great Britain: a retrospective cohort study","volume":"10","author":"Pierotti","year":"2018","journal-title":"J Transport Health"},{"key":"2025081221072315300_bib16","doi-asserted-by":"publisher","first-page":"1048","DOI":"10.1038\/s41598-024-51554-1","article-title":"Association of fine particulate matter (PM(2.5)) exposure and chronic kidney disease outcomes: a systematic review and meta-analysis","volume":"14","author":"Wathanavasin","year":"2024","journal-title":"Sci Rep"},{"key":"2025081221072315300_bib17","doi-asserted-by":"publisher","first-page":"110867","DOI":"10.1016\/j.envres.2021.110867","article-title":"Ambient air pollution exposure and risk of chronic kidney disease: a systematic review of the literature and meta-analysis","volume":"195","author":"Ye","year":"2021","journal-title":"Environ Res"},{"key":"2025081221072315300_bib18","doi-asserted-by":"publisher","first-page":"e23610","DOI":"10.1002\/jbt.23610","article-title":"Association of air pollution and risk of chronic kidney disease: a systematic review and meta-analysis","volume":"38","author":"Xu","year":"2024","journal-title":"J Biochem Molecular Tox"},{"key":"2025081221072315300_bib19","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1681\/ASN.2017030253","article-title":"Particulate matter air pollution and the risk of incident CKD and progression to ESRD","volume":"29","author":"Bowe","year":"2018","journal-title":"J Am Soc Nephrol"},{"key":"2025081221072315300_bib20","doi-asserted-by":"publisher","first-page":"147471","DOI":"10.1016\/j.scitotenv.2021.147471","article-title":"Effects of air pollution on mortality of patients with chronic kidney disease: a large observational cohort study","volume":"786","author":"Jung","year":"2021","journal-title":"Sci Total Environ"},{"key":"2025081221072315300_bib21","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1186\/s12302-020-00378-7","article-title":"PM2.5 exposure induced renal injury via the activation of the autophagic pathway in the rat and HK-2 cell","volume":"32","author":"Huang","year":"2020","journal-title":"Environ Sci Eur"}],"container-title":["Clinical Kidney Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ckj\/advance-article-pdf\/doi\/10.1093\/ckj\/sfaf222\/63734158\/sfaf222.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ckj\/article-pdf\/18\/8\/sfaf222\/63734158\/sfaf222.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ckj\/article-pdf\/18\/8\/sfaf222\/63734158\/sfaf222.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T01:07:27Z","timestamp":1755047247000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ckj\/article\/doi\/10.1093\/ckj\/sfaf222\/8197884"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,12]]},"references-count":21,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2025,8,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ckj\/sfaf222","relation":{},"ISSN":["2048-8505","2048-8513"],"issn-type":[{"value":"2048-8505","type":"print"},{"value":"2048-8513","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,8]]},"published":{"date-parts":[[2025,7,12]]},"article-number":"sfaf222"}}