The Treatment of Antibody-Mediated Rejection in Kidney Transplantation: An Updated Systematic Review and Meta-Analysis
1Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, Australia
2Sydney Medical School, University of Sydney, Sydney, Australia
3Department of Renal Medicine, Canberra Hospital and Health Services, Canberra, Australia
4Medical School, Australian National University, Canberra, Australia.
Meeting: 2018 American Transplant Congress
Abstract number: A120
Keywords: Alloantibodies, Kidney transplantation, Meta-analysis, Rejection
Session Information
Session Name: Poster Session A: Kidney Acute Antibody Mediated Rejection
Session Type: Poster Session
Date: Saturday, June 2, 2018
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall 4EF
Introduction: Current treatment strategies for antibody-mediated rejection (AMR) in kidney transplantation are based on low quality data from a small number of controlled trials. Novel agents targeting B-cells, plasma-cells and the complement system have featured in recent studies of AMR.
Methods: We conducted an updated systematic review and meta-analysis of controlled trials in kidney transplant recipients using Medline, EMBASE and CENTRAL from inception to February 2017. The primary outcome was graft survival and secondary outcomes included graft function and adverse events.
Results: Of 14,380 citations we identified 21 controlled studies, including 10 randomised controlled trials, involving a total of 751 participants. Since the last systematic review conducted in 2011 that included 12 studies, the updated search found 9 additional studies evaluating: plasmapheresis + intravenous immunoglobulin (IVIG) (2), rituximab (2), bortezomib (2), C1-inhibitor (2), and eculizumab (1). Risk of bias was serious or unclear overall and evidence quality was low for the majority of treatment strategies. Sufficient RCTs for pooled analysis were available only for the comparison between antibody removal and control, and here there was no significant difference between groups for graft survival (HR 0.76; 95% Confidence Interval 0.35–1.63; P=0.475, Figure 1). Studies showed important heterogeneity in treatments, definition of AMR, quality and follow-up. Plasmapheresis and IVIG were frequently used as standard-of-care in recent studies, and to this combination rituximab appeared to add little or no benefit. Insufficient data are available to assess the efficacy of bortezomib and complement inhibitors.
Conclusions: Despite limited low certainty evidence, plasmapheresis and IVIG have emerged as standard of care for the treatment of acute AMR.
CITATION INFORMATION: Wan S., Ying T., Wyburn K., Roberts D., Wyld M., Chadban S. The Treatment of Antibody-Mediated Rejection in Kidney Transplantation: An Updated Systematic Review and Meta-Analysis Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Wan S, Ying T, Wyburn K, Roberts D, Wyld M, Chadban S. The Treatment of Antibody-Mediated Rejection in Kidney Transplantation: An Updated Systematic Review and Meta-Analysis [abstract]. https://atcmeetingabstracts.com/abstract/the-treatment-of-antibody-mediated-rejection-in-kidney-transplantation-an-updated-systematic-review-and-meta-analysis/. Accessed November 23, 2024.« Back to 2018 American Transplant Congress