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

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.

 Fuente: Transplantation Reviews, 2023, 37, 100795

 Editorial: Elsevier

 Año de publicación: 2023

 Nº de páginas: 12

 Tipo de publicación: Artículo de Revista

 DOI: 10.1016/j.trre.2023.100795

 ISSN: 0955-470X,1557-9816

 Url de la publicación: https://doi.org/10.1016/j.trre.2023.100795

Autoría

MONTERO, NURIA

CRESPO, MART

CRUZADO, JOSEP M.

GUTIÉRREZ-DALMAU, ALEX

MAZUECOS, AUXILIADORA

SANCHO, ASUNCIÓN

LARA BELMAR VEGA

CALATAYUD, EMMA

MORA, PAULA

OLIVERAS, LAIA

SOLÀ, EULALIA

VILLANEGO, FLORENTINO

PASCUAL, JULIO