The Treatment of Acute Antibody-Mediated Rejection in Kidney Transplant Recipients—A Systematic Review
2012; Wolters Kluwer; Volume: 94; Issue: 8 Linguagem: Inglês
10.1097/tp.0b013e31825d1587
ISSN1534-6080
AutoresDarren M. Roberts, Simon Jiang, Steven J. Chadban,
Tópico(s)Transplantation: Methods and Outcomes
ResumoBackground Antibody-mediated rejection (AMR) is a recognized cause of allograft loss in kidney transplant recipients. A range of therapies targeting removal of circulating donor-specific antibodies (DSAs), blocking their effect or reducing production have been reported. Methods We conducted a systematic review to determine the efficacy of treatments for acute AMR in renal allografts. Electronic databases, reference lists, and conference proceedings were searched for controlled trials. Nonrandomized publications were reviewed for the purpose of discussion. Results We identified 10,388 citations, including five randomized and seven nonrandomized controlled trials. The randomized studies were small (median, 13 patients/arm; range, 5–23), of which, four examined plasmapheresis (one suggested benefit) and one for immunoadsorption (also suggesting benefit). Marked heterogeneity was evident, including the definition and severity of AMR and the treatment regimen. The end point of graft survival was common to all studies. Small, nonrandomized controlled studies suggested benefit from rituximab or bortezomib. The effects of dose and regimen on the clinical response to any of the current treatments were not apparent from the available data. Conclusions Data describing the efficacy of treatments for AMR in renal allografts are of low or very low quality. Larger randomized controlled trials and dose-response studies are required.
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