Outcomes of Kidney Transplantation in Highly HLA-Sensitized Patients Treated with Intravenous Immuno-Globulin, Plasmapheresis and Rituximab: A Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Sources and Search Strategy
2.2. Study Selection
2.3. Assessed Outcomes
2.4. Data Extraction
2.5. Statistical Analysis
2.6. Quality Assessment and Risk of Bias
2.7. Ethical Approval and Consent to Participate
3. Results
3.1. Search Strategy Results
3.2. Study Characteristics
3.3. Patient Characteristics
3.4. Outcomes
3.5. Quality Assessment and Risk of Bias
3.6. Heterogeneity
3.7. Sensitivity Analysis
3.8. Publication Bias
4. Discussion
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Study | Year | Study Period | Country | Total, n | Age (Years), Mean ± SD | Females, n | Dialysis Vintage, in Months, Mean ± SD | Re-Transplant, n | PRA, Mean ± SD | Positive CDC Crossmatch, n | Follow-Up Period (Months), Mean ± SD |
---|---|---|---|---|---|---|---|---|---|---|---|
Amrouche et al. [2] | 2017 | 2002–2009 | France | 95 | 46.6 ± 12.2 | 51 | - | - | - | 30 | 80.3 ± 40.8 |
Bansal et al. [21] | 2021 | 2014–2018 | India | 12 | 39.9 ± 14.4 | 7 | 8.8 ± 15.2 | 0 | - | 0 | 26.6 ± 13.9 |
De Sousa-Amorim et al. [22] | 2015 | 2008–2014 | Spain | 24 | 41 ± 13 | 13 | - | 18 | 76 ± 136 | 1 | 37 ± 27 |
Ishida et al. [23] | 2021 | 2011–2020 | Japan | 41 | 52 ± 13 | 22 | 51.6 ± 25.2 | 21 | - | 41 | - |
Jin et al. [24] | 2012 | 2003–2009 | Korea | 7 | 51.4 ± 3.3 | 6 | - | - | 41.7 ± 6.1 | 6 | 33.2 ± 5.4 |
Kahwaji et al. [25] | 2016 | 2006–2010 | USA | 66 | - | 43 | 2.73 ± 2.61 | 33 | 71 ± 2.32 | 53 | 68 ± 15 |
Keven et al. [26] | 2013 | - | Turkey | 5 | 40.4 ± 20.9 | 5 | - | 2 | - | 0 | 17 |
Loupy et al. [27] | 2010 | 2002–2007 | France | 18 | 45 ± 12 | - | - | - | 7 | 19.5 ± 9.3 | |
Okada et al. [28] | 2018 | 2012–2015 | Japan | 15 | 48.9 ± 13.7 | 9 | 48.33 ± 45.9 | 7 | - | 15 | 39.6 ± 12 |
Reilla et al. [29] | 2014 | 2002–2010 | USA | 39 | 43.1 ± 13 | 27 | - | 27 | 47.8 ± 31 | 39 | 60 |
Santos et al. [30] | 2014 | 1999–2013 | Portugal | 8 | 42 ± 12 | 6 | 168 ± 97.2 | 6 | 62 ± 36 | - | 29.8 ± 35.1 |
Stegall et al. [31] | 2006 | 2000–2005 | USA | 61 | 46.1 ± 16.3 | 32 | - | - | - | - | 60 |
West-Thielke et al. [32] | 2008 | 2001–2007 | USA | 28 | 41.9 ± 9.6 | 21 | 51.6 ± 67.9 | 4 | 66.1 ± 31.8 | 28 | - |
Yilmaz et al. [33] | 2020 | 2011–2018 | Turkey | 16 | 35 ± 12 | 8 | - | 11 | 53 ± 37 | 14 | 39 ± 24 |
Yoon et al. [34] | 2009 | 2003–2007 | Korea | 10 | 47.5 ± 8.4 | 7 | - | 3 | - | 6 | 52 |
Zhang et al. [35] | 2011 | 2008–2010 | China | 14 | 43.6 ± 7.4 | 6 | - | 10 | - | - | - |
Study | Total, n | IVIg Dose | Plasmapheresis | Rituximab Dose | Controls in the Study | Induction Agent | Post-Transplant Immunosuppression | 1-Year Death-Censored Graft Survival, % | 5-Year Death-Censored Graft Survival, % | 1-Year Patient Survival, % | 5-Year Patient Survival, % |
---|---|---|---|---|---|---|---|---|---|---|---|
Amrouche et al. [2] | 95 | 2 g/kg | 5–10 sessions | 375 mg/m2 | 39 patients with an MFI between 500 and 3000 | Thymoglobulin | Tac + MMF + Prednisone | 98% | 86% | 97% | 85% |
Bansal et al. [21] | 12 | 100 mg/kg | 1–9 sessions | 200 mg, 2–3 weeks before transplant | None | Thymoglobulin | Tac + MMF + Prednisone | 100% | - | 100% | - |
De Sousa-Amorim et al. [22] | 24 | 100 mg/kg | 1–21 sessions | Two doses of 400 mg, 3–4 weeks before transplantation | None | Thymoglobulin | Tac + MMF + Prednisone | 91% | 86% | - | 95.9% |
Ishida et al. [23] | 41 | 2 g/kg | 3–4 sessions | 200 mg and 300 mg on two separate days | None | NR | Tac + MMF + Prednisone | 90% | - | - | - |
Jin et al. [24] | 7 | 100 mg/kg | 6 sessions | 375 mg/m2, 2 weeks before transplant | None | Basiliximab | Tac + MMF + Prednisone | 100% | 100% | 100% | 100% |
Kahwaji et al. [25] | 66 | 2 g/kg | 5 sessions | 1 gm | 111 patients with a low PRA | Alemtuzumab | Tac + MMF + Prednisone | - | 90.6% | - | 94% |
Keven et al. [26] | 5 | NR | 2 sessions | 200 mg, one day before transplantation | None | Basiliximab | Tac + MMF + Prednisone | 100% | - | 100% | - |
Loupy et al. [27] | 18 | 2 g/kg | 9 sessions | 375 mg/m2 | 36 patients received no rituximab | Thymoglobulin | Tac/Cyclosporin + MMF + Prednisone | 88.9% | - | 94.5% | - |
Okada et al. [28] | 15 | 2 g/kg | 2–4 sessions | 300 mg one month before and 200 mg the day before transplantation | 229 crossmatch-ve, DSA -ve | Basiliximab | Tac + MMF + Prednisone | 86.7% | - | 93.3% | - |
Reilla et al. [29] | 39 | NR | Average of 5.6 sessions | 375 mg/m2, one day before transplantation | None | Basiliximab (58%), Thymoglobulin (42%) | Tac + MMF + Prednisone | 94% | 84% | 95% | 86% |
Santos et al. [30] | 8 | NR | 3–9 sessions | 375 mg/m2 | 8 patients with a positive flow cytometry crossmatch who were not desensitized | Thymoglobulin | Tac + MMF + Prednisone/Cyclosporine + Azathioprine + Prednisone | 100% | 71% | 88% | - |
Stegall et al. [31] | 61 | 100 mg/kg | 4–5 sessions | 375 mg/m2, 4–7 days before transplantation | 13 patients high lose IVIg | Thymoglobulin | Tac + MMF + Prednisone | 82% | - | 93% | - |
West-Thielke et al. [32] | 28 | NR | 1–4 sessions | 375 mg/m2 | 22 patients who were not African Americans with a positive crossmatch | Thymoglobulin | Tac + MMF + Prednisone | 82.6% | - | 91% | - |
Yilmaz et al. [33] | 16 | NR | Average of 3.5 sessions | 375 mg/m2 | 33 patients received no rituximab | Thymoglobulin | Tac + MMF + Prednisone | 93.8% | 85.2% | 100% | 100% |
Yoon et al. [34] | 10 | NR | 6 sessions | 375 mg/m2, one day before transplantation | None | Basiliximab | Tac + MMF + Prednisone | 90% | - | 100% | - |
Zhang et al. [35] | 14 | 100 mg/kg | 4–5 sessions | 375 mg/m2, one week before and one day before transplantation | None | Thymoglobulin | Tac + MMF + Prednisone | 92.8% | - | 100% | - |
Outcome | Pooled Rate (%) | 95% Confidence Interval | Heterogeneity (%) | No. of Studies Reporting the Outcome | Total No. of Patients in the Studies |
---|---|---|---|---|---|
1-year graft survival | 88.9 | 84.8–92 | 0 | 14 | 377 |
5-year graft survival | 86.1 | 81.2–89.9 | 0 | 7 | 255 |
1-year patient survival | 94.2 | 91–96.3 | 0 | 13 | 328 |
5-year patient survival | 88.9 | 83.5–92.7 | 7.7 | 6 | 247 |
Antibody-mediated rejection | 37.7 | 25–52.3 | 80.3 | 11 | 375 |
Acute cell-mediated rejection | 15.1 | 9.1–24 | 55 | 10 | 319 |
Urinary tract infections | 17.1 | 4.5–47.6 | 81.5 | 7 | 113 |
Cytomegalovirus infections | 8.7 | 5.2–14.1 | 0 | 8 | 185 |
BK nephropathy | 10 | 6–16.2 | 0 | 6 | 149 |
Study | Representativeness of the Average Adult in Community | Cohort Size | Information on Outcomes | Outcome Not Present at Start | Additional Intervention | Adequate Assessment | Follow-Up Time | Adequacy of Follow-Up | Max 7, High > 5, Medium 3–5, Low <3 |
---|---|---|---|---|---|---|---|---|---|
Population-Based: 1; Multi-Center: 0.5; Single-Center: 0 | >40 Patients: 1; 39 to 20: 0.5; <20: 0 | Information with Clarity: 1; Information Derived: 0.5 | Not Present: 1; Present: 0 | Yes: 1; No: 0 | Yes: 1; No: 0 | Yes: 1; Not Mentioned: 0 | All Patients Followed-Up: 1; >50% Followed-Up: 0.5; <50% Followed-Up OR Not Mentioned: 0 | ||
Amrouche et al. [2] | 0 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 6 |
Bansal et al. [21] | 0 | 0 | 1 | 0 | 1 | 1 | 1 | 1 | 5 |
De Sousa-Amorim et al. [22] | 0 | 0.5 | 1 | 1 | 1 | 1 | 1 | 1 | 6.5 |
Ishida et al. [23] | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 6 |
Jin et al. [24] | 0 | 0 | 1 | 0 | 1 | 1 | 1 | 1 | 5 |
Kahwaji et al. [25] | 0 | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 6 |
Keven et al. [26] | 0 | 0 | 1 | 0 | 1 | 0 | 1 | 1 | 4 |
Loupy et al. [27] | 0 | 0 | 1 | 0 | 1 | 1 | 1 | 1 | 5 |
Okada et al. [28] | 0 | 0 | 1 | 0 | 1 | 1 | 1 | 1 | 5 |
Reilla et al. [29] | 0 | 0.5 | 1 | 0 | 1 | 1 | 1 | 1 | 5.5 |
Santos et al. [30] | 0 | 0 | 0.5 | 1 | 1 | 0 | 1 | 1 | 4.5 |
Stegall et al. [31] | 0 | 1 | 0.5 | 1 | 1 | 1 | 1 | 1 | 6 |
West-Thielke et al. [32] | 0 | 0.5 | 1 | 1 | 1 | 1 | 1 | 1 | 6.5 |
Yilmaz et al. [33] | 0 | 0 | 0.5 | 1 | 1 | 0 | 1 | 1 | 4.5 |
Yoon et al. [34] | 0 | 0 | 0.5 | 1 | 1 | 0 | 1 | 1 | 4.5 |
Zhang et al. [35] | 0 | 0 | 0.5 | 1 | 1 | 0 | 1 | 1 | 4.5 |
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Chandramohan, D.; Adisa, O.; Patel, D.; Ware, E.; Eleti, N.; Agarwal, G. Outcomes of Kidney Transplantation in Highly HLA-Sensitized Patients Treated with Intravenous Immuno-Globulin, Plasmapheresis and Rituximab: A Meta-Analysis. Life 2024, 14, 998. https://doi.org/10.3390/life14080998
Chandramohan D, Adisa O, Patel D, Ware E, Eleti N, Agarwal G. Outcomes of Kidney Transplantation in Highly HLA-Sensitized Patients Treated with Intravenous Immuno-Globulin, Plasmapheresis and Rituximab: A Meta-Analysis. Life. 2024; 14(8):998. https://doi.org/10.3390/life14080998
Chicago/Turabian StyleChandramohan, Deepak, Oluwadamilola Adisa, Devansh Patel, Erin Ware, Navya Eleti, and Gaurav Agarwal. 2024. "Outcomes of Kidney Transplantation in Highly HLA-Sensitized Patients Treated with Intravenous Immuno-Globulin, Plasmapheresis and Rituximab: A Meta-Analysis" Life 14, no. 8: 998. https://doi.org/10.3390/life14080998