The use of lymphocyte-depleting antibodies in specific populations of kidney transplant recipients: A systematic review and meta-analysis

IF 3.6 2区医学 Q2 IMMUNOLOGY

Transplantation Reviews Pub Date : 2023-09-21 DOI:10.1016/j.trre.2023.100795

Nuria Montero , Emilio Rodrigo , Marta Crespo , Josep M. Cruzado , Alex Gutierrez-Dalmau , Auxiliadora Mazuecos , Asunción Sancho , Lara Belmar , Emma Calatayud , Paula Mora , Laia Oliveras , Eulalia Solà , Florentino Villanego , Julio Pascual

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引用次数: 0

Abstract

Background

Recommendations of the use of antibody induction treatments in kidney transplant recipients (KTR) are based on moderate quality and historical studies. This systematic review aims to reevaluate, based on actual studies, the effects of different antibody preparations when used in specific KTR subgroups.

Methods

We searched MEDLINE and CENTRAL and selected randomized controlled trials (RCT) and observational studies looking at different antibody preparations used as induction in KTR. Comparisons were categorized into different KTR subgroups: standard, high risk of rejection, high risk of delayed graft function (DGF), living donor, and elderly KTR. Two authors independently assessed the risk of bias.

Results

Thirty-seven RCT and 99 observational studies were finally included. Compared to anti-interleukin-2-receptor antibodies (IL2RA), anti-thymocyte globulin (ATG) reduced the risk of acute rejection at two years in standard KTR (RR 0.74, 95%CI 0.61–0.89) and high risk of rejection KTR (RR 0.55, 95%CI 0.43–0.72), but without decreasing the risk of graft loss. We did not find significant differences comparing ATG vs. alemtuzumab or different ATG dosages in any KTR group.

Conclusions

Despite many studies carried out on induction treatment in KTR, their heterogeneity and short follow-up preclude definitive conclusions to determine the optimal induction therapy. Compared with IL2RA, ATG reduced rejection in standard-risk, highly sensitized, and living donor graft recipients, but not in high DGF risk or elderly recipients. More studies are needed to demonstrate beneficial effects in other KTR subgroups and overall patient and graft survival.

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淋巴细胞消耗抗体在肾移植受者特定人群中的应用：一项系统综述和荟萃分析。

背景：建议在肾移植受者（KTR）中使用抗体诱导治疗是基于中等质量和历史研究。本系统综述旨在根据实际研究，重新评估不同抗体制剂在特定KTR亚组中使用的效果。方法：我们检索了MEDLINE和CENTRAL，并选择了随机对照试验（RCT）和观察性研究，观察了用于KTR诱导的不同抗体制剂。将比较分为不同的KTR亚组：标准、高排异风险、高移植物功能延迟风险（DGF）、活体供体和老年KTR。两位作者独立评估了偏倚的风险。结果：最终纳入了37项随机对照试验和99项观察性研究。与抗白细胞介素2受体抗体（IL2RA）相比，抗胸腺细胞球蛋白（ATG）在标准KTR中降低了两年急性排斥反应的风险（RR 0.74，95%CI 0.61-0.89）和高排斥反应风险（RR 0.55，95%CI 0.43-0.72），但没有降低移植物丢失的风险。我们没有发现在任何KTR组中比较ATG与阿仑单抗或不同ATG剂量的显著差异。结论：尽管对KTR的诱导治疗进行了许多研究，但它们的异质性和短期随访阻碍了确定最佳诱导治疗的明确结论。与IL2RA相比，ATG在标准风险、高度致敏和活体供体移植物受体中降低了排斥反应，但在DGF高风险或老年受体中没有降低。需要更多的研究来证明对其他KTR亚组以及患者和移植物的总体存活率的有益作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplantation Reviews IMMUNOLOGY-TRANSPLANTATION

CiteScore

7.50

自引率

2.50%

发文量

审稿时长

29 days

期刊介绍： Transplantation Reviews contains state-of-the-art review articles on both clinical and experimental transplantation. The journal features invited articles by authorities in immunology, transplantation medicine and surgery.