The treatment of acute antibody-mediated rejection in kidney transplant recipients - a systematic review

Roberts, Darren M., Jiang, Simon H. and Chadban, Steven J. (2012) The treatment of acute antibody-mediated rejection in kidney transplant recipients - a systematic review. Transplantation, 94 8: 775-783. doi:10.1097/TP.0b013e31825d1587


Author Roberts, Darren M.
Jiang, Simon H.
Chadban, Steven J.
Title The treatment of acute antibody-mediated rejection in kidney transplant recipients - a systematic review
Journal name Transplantation   Check publisher's open access policy
ISSN 0041-1337
1534-6080
Publication date 2012-10-27
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1097/TP.0b013e31825d1587
Open Access Status DOI
Volume 94
Issue 8
Start page 775
End page 783
Total pages 9
Place of publication Philadelphia, PA, United States
Publisher Lippincott Williams & Wilkins
Language eng
Formatted abstract
Background: 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.
Keyword Antibody
Rejection
Kidney Transplantation
Treatment
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2013 Collection
School of Medicine Publications
 
Versions
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 74 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 85 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Sun, 02 Dec 2012, 11:00:34 EST by System User on behalf of School of Medicine