Acute Cellular Rejection and Infection Rates in Alemtuzumab vs Traditional Induction Therapy Agents for Lung and Heart Transplantation: A Systematic Review and Meta-analysis

Li, K.H.C.; Recaldin, B; Gong, Mengqi; Ho, Jeffery; Li, G.; Liu, T.; Wu, William Ka Kei; Wong, Martin C. S.; Dong, Mei; Tse, Gary

doi:10.1016/j.transproceed.2018.08.044

Cited by 12 publications

(5 citation statements)

References 24 publications

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“…Importantly, there was a 4-year survival advantage in both single and bilateral lung transplant recipients receiving an IL-2 receptor antagonist versus no induction [relative risk (RR) =0.82; 95% confidence interval (CI): 0.71-0.95, P=0.007] independent of other risk factors. Induction with ATG The superiority of using one induction agent over another has not been proven, although most (but not all) studies tend to favor basiliximab and alemtuzumab over ATG (22,(24)(25)(26)(27)(28). A 2013 Cochrane review found no clear benefits or harms when comparing the different induction agents (22).…”

Section: Induction Immunosuppressionmentioning

confidence: 99%

Immunosuppressive strategies in lung transplantation

Chung¹,

Dilling²

2020

Ann Transl Med

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Lung transplantation is a viable option for those with end-stage lung disease which is evidenced by the continued increase in the number of lung transplantations worldwide. However, patients and clinicians are constantly faced with acute and chronic rejection, infectious complications, drug toxicities, and malignancies throughout the lifetime of the lung transplant recipient. Conventional maintenance immunosuppression therapy consisting of a calcineurin inhibitor (CNI), anti-metabolite, and corticosteroids have become the standard regimen but newer agents and modalities continue to be developed. Here we will review induction agents, maintenance immunosuppressives, adjunctive therapies and other strategies to improve long-term outcomes.

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Section: Induction Immunosuppressionmentioning

confidence: 99%

Immunosuppressive strategies in lung transplantation

Chung¹,

Dilling²

2020

Ann Transl Med

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“…A major advantage to the lower CNI exposure is reduced toxicity, such as decreased prevalence of renal impairment. A recent systematic review of retrospective data also reported lower rates of acute rejection after alemtuzumab induction compared with conventional induction agents, but there are no prospective studies available confirming such results yet [126]. However, we can conclude that there is some evidence in favour of induction therapy and its application is increasing; however, it is not standard practice in all centres at this point.…”

Section: Induction Therapymentioning

confidence: 83%

Developments in lung transplantation over the past decade

2020

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With an improved median survival of 6.2 years, lung transplantation has become an increasingly acceptable treatment option for end-stage lung disease. Besides survival benefit, improvement of quality of life is achieved in the vast majority of patients. Many developments have taken place in the field of lung transplantation over the past decade. Broadened indication criteria and bridging techniques for patients awaiting lung transplantation have led to increased waiting lists and changes in allocation schemes worldwide. Moreover, the use of previously unacceptable donor lungs for lung transplantation has increased, with donations from donors after cardiac death, donors with increasing age and donors with positive smoking status extending the donor pool substantially. Use of ex vivo lung perfusion further increased the number of lungs suitable for lung transplantation. Nonetheless, the use of these previously unacceptable lungs did not have detrimental effects on survival and long-term graft outcomes, and has decreased waiting list mortality. To further improve long-term outcomes, strategies have been proposed to modify chronic lung allograft dysfunction progression and minimise toxic immunosuppressive effects. This review summarises the developments in clinical lung transplantation over the past decade.

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“…The presence of a high frequency of serious conduction disturbances may be associated with T-cell-mediated cytotoxicity, which affects the cardiac conduction system. Histological studies have shown that ICI-mediated cardiomyocyte necrosis is characterized by the infiltration of CD4+ and CD8+ T-cells and is similar to the development of acute cardiac rejection after transplantation [ 205 , 206 ]. Lymphocytic infiltration may involve the sinoatrial and atrioventricular nodes [ 207 ].…”

Section: Discussionmentioning

confidence: 99%

Immune Checkpoint Inhibitors-Related Myocarditis: A Review of Reported Clinical Cases

Zotova

2023

Diagnostics

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Myocarditis associated with the use of immune checkpoint inhibitors (ICI) is a rare manifestation of their cardiotoxicity, but is characterized by a high mortality rate. A literature search was conducted using PubMed using keywords, which resulted in the selection of 679 scientific works, from which 160 articles that described 244 clinical cases were selected. The median age of the patients was 67 years (IQR, 60–74). The median time from the start of ICI therapy to the development of the first adverse symptoms was 21 days (IQR, 14–38.3). In 37% of cases, myocarditis developed after the first administration of ICI. Cardiac symptoms were present in 47.1% of cases, neuromuscular symptoms in 30.3%, and other symptoms in 12.6%, while myocarditis was asymptomatic in 10.1% of cases. New changes in the electrocardiograms were detected in 85.1% of patients compared to the initial data. A high incidence of complete atrioventricular block (25.4%), right bundle branch block (18.4%), ventricular tachycardia (13%), and sinus tachycardia (12%) were noted. In 97% of the cases, the patients received prednisolone or methylprednisolone therapy. When using ICI, special attention should be paid to the early detection of possible cardiotoxicity by analyzing the condition and function of the myocardium before treatment and its dynamics.

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Acute Cellular Rejection and Infection Rates in Alemtuzumab vs Traditional Induction Therapy Agents for Lung and Heart Transplantation: A Systematic Review and Meta-analysis

Cited by 12 publications

References 24 publications

Immunosuppressive strategies in lung transplantation

Immunosuppressive strategies in lung transplantation

Developments in lung transplantation over the past decade

Immune Checkpoint Inhibitors-Related Myocarditis: A Review of Reported Clinical Cases

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