Polyclonal and monoclonal antibodies for treating acute rejection episodes in kidney transplant recipients

摘要: Background Registry data shows that the incidence of acute rejection has been steadily falling. Approximately 10% to 35% kidney recipients will undergo treatment for at least one episode within first post-transplant year. Treatment options include pulsed steroid therapy, use an antibody preparation, alteration background immunosuppression, or combinations these options. Over recent years, new strategies have evolved, and in many parts world there increase tacrolimus mycophenolate a reduction cyclosporin azathioprine as baseline immunosuppression prevent rejection. There are also global variations polyclonal monoclonal antibodies treat This is update review published 2006. Objectives The aim this systematic was to: (1) evaluate relative absolute effects different classes preparation preventing graft loss resolving cellular humoral episodes when used transplant recipients; (2) steroid-resistant (3) determine how benefits adverse events vary each type preparation; (4) harms formulations type. Search methods We searched Cochrane Kidney Transplant Specialised Register 18 April 2017 through contact with Information Specialist using search terms relevant review. Selection criteria Randomised controlled trials (RCTs) all languages comparing mono- preparations, given combination any other immunosuppressive agents, rejection, compared were eligible inclusion. Data collection analysis Two authors independently assessed risk bias included studies extracted data. Statistical analyses performed random-effects model results expressed ratio (RR) mean difference (MD) 95% confidence intervals (CI). Main results We 11 (18 reports, 346 participants) update, bring total number 31 (76 1680 participants). Studies generally small, incompletely reported, especially potential harms, did not define outcome measures adequately. The inadequate unclear random sequence generation (81%), allocation concealment (87%) (87%). were, however, predominance low blinding (75%) incomplete (80%) across studies. Selective reporting had mixture (58%), high (29%), (13%) bias. Seventeen (1005 therapies episodes. Antibody therapy probably better than reversing (RR 0.50, CI 0.30 0.82; moderate certainty) subsequent 0.70, 0.50 0.99; certainty), may be (death censored: 0.80, 0.57 1.12; but little no death Adverse (including fever, chills malaise following drug administration) reduced 23.88, 5.10 111.86; I2 = 16%; certainty). Twelve (576 patients) investigated benefit muromonab-CD3 over ATG ALG death. Two rituximab (58 patients). Muromonab-CD3 treated patients suffered three times more those receiving either T10B9, from syndrome administration 3.12, 1.87 5.21; 31%), experienced neurological side 13.10 1.43 120.05; 36%) (low certainty evidence). There evidence additional reversal 0.94, 0.54 1.64), 12 months 1.0, 0.23 4.35). Rituximab plus steroids increases urinary tract infection/pyelonephritis 5.73, 1.80 18.21). Authors' conclusions In loss, steroid, patient survival. In between period months, limited beyond time frame. treating conferred loss. Although updated review, majority newer provide cyclosporin/azathioprine era transplantation therefore conclusions cannot necessarily extrapolated contemporary regimens which tacrolimus/mycophenolate sirolimus. However, centres around continue older regimes findings remain strongly their clinical practice. Larger standardised reproducible criteria needed investigate outcomes risks treatments regimes.