Antibody induction versus placebo, no induction, or another type of antibody induction for liver transplant recipients

Penninga, Luit; Wettergren, André; Chan, An‐Wen; Gluud, Christian

doi:10.1002/14651858.cd010253.pub2

Cited by 22 publications

(21 citation statements)

References 94 publications

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“… 15 In a meta-analysis of liver transplant recipients, AR was significantly less frequent when any form of T cell–specific antibody induction was used compared with no induction (relative risk, 0.85; P <0.05). 16 The meta-analysis did not mirror typical practice patterns in the US, however, as included studies were limited to 19 trials with corticosteroids administered in all and MPA/AZA in 15 of the 19 trials. Thus, further study is needed to compare the benefits and risks of early triple ISx, lower intensity ISx with induction, and lower intensity ISx without induction.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Center-driven and Clinically Driven Variation in US Liver Transplant Maintenance Immunosuppression Therapy: A National Practice Patterns Analysis

Nazzal

Lentine

Naik

et al. 2018

Transplantation Direct

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Section: Discussionmentioning

confidence: 99%

“…Thus, further study is needed to compare the benefits and risks of early triple ISx, lower intensity ISx with induction, and lower intensity ISx without induction. 2 , 7 , 16 …”

Section: Discussionmentioning

confidence: 99%

Center-driven and Clinically Driven Variation in US Liver Transplant Maintenance Immunosuppression Therapy: A National Practice Patterns Analysis

Nazzal

Lentine

Naik

et al. 2018

Transplantation Direct

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“…In a recent meta-analysis of 2067 liver transplant recipients, antibody induction was generally effective at reducing the incidence of acute rejection after transplantation, but overall comparable results also were obtained with use of any of these antibody-based treatments. The authors stated that comparison was difficult because of significant variations in the patients' risk profiles, maintenance therapy, small number of randomized trials and the limited numbers of events [28]. Taken together, these studies indicate that antibody induction reduces the incidence of acute rejection after SOT although the long-term efficacy and the relative merits of each protocol remain unclear.…”

Section: Key Pointsmentioning

confidence: 99%

Acute rejection in vascularized composite allotransplantation

Fischer

Lian

Kueckelhaus

et al. 2014

Current Opinion in Organ Transplantation

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Acute rejection is higher in VCA than in any other organ in the field of transplantation, although most episodes are controlled by high-dose steroids and optimization of maintenance immunosuppression. Because of limitations in patient number and the duration of follow-up, the long-term safety and effectiveness of VCA remain unclear. Moreover, the tests currently used to diagnose acute rejection are of limited value. Better diagnostic tools and a better understanding of the immunologic events during acute rejection are therefore needed to improve diagnosis, treatment and outcomes of this life-changing restorative surgery.

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“…Several of the available reports do not differentiate between types of lymphocyte-depleting induction therapy. Analyses which included patients treated with OTK3 [8,71,72], in particular, are of limited value when assessing an effect of rATG in view of the profound increase in lymphoma risk associated with OKT3 [16,46,53]. Table 4 summarizes the most relevant retrospective studies.…”

Section: Retrospective Studiesmentioning

confidence: 99%

“…The studies included in the analysis did not, however, permit comparisons with no induction or other types of induction agent since few were designed to compare rATG therapy with other regimens. Two Cochrane database analyses have included information on the risk of PTLD after liver [71] or lung [81] transplantation. In both analyses, no difference in the rate of PTLD was found between patients given any type of T-cell antibody induction (including rATG, ATGAM or ALG) versus no induction [71,81], but the robustness of the data were limited by a relative paucity of studies.…”

Section: Pooled Datamentioning

confidence: 99%

Rabbit antithymocyte globulin induction and risk of post-transplant lymphoproliferative disease in adult and pediatric solid organ transplantation: An update

Hertig

Zuckermann

2015

Transplant Immunology

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The most modifiable risk factor for post-transplant lymphoproliferative disease (PTLD) is the type and dose of induction and maintenance immunosuppressive therapy. It is challenging to identify the contribution of a single agent such as rabbit antithymocyte globulin (rATG) in the setting of multidrug therapy. Registry analyses can be helpful but are limited by methodological restrictions and inclusion of historical patient cohorts. These are typically from eras when rATG dosing was markedly higher than current dosing (e.g. total dose 14 mg/kg versus 6 mg/kg now), accompanied by higher exposure to maintenance therapies, and often an absence of antiviral prophylaxis. The largest registry analysis to assess rATG specifically found no risk of PTLD after kidney transplantation, but conflicting results have been reported, highlighting the difficulty of interpreting this type of analysis. The relative rarity of PTLD means that individually controlled trials are underpowered to assess its occurrence, but the available data do not suggest an effect of rATG. A pooled analysis of data from studies of rATG induction in kidney and heart transplantation found the incidence of PTLD to be comparable to published reports in the overall transplant population. Data on the effect of rATG dose are inconclusive, but in patients receiving antiviral prophylaxis it does not appear to be influential. Nevertheless, it would seem reasonable to employ the lowest dose of rATG compatible with effective induction, particularly in EBV-seronegative recipients and other high-risk groups such as heart-lung transplant recipients. Overall, the risk of PTLD following rATG induction therapy with modern dosing regimens and under current management conditions appears unlikely to make an important contribution to the risk:benefit balance.

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Antibody induction versus placebo, no induction, or another type of antibody induction for liver transplant recipients

Cited by 22 publications

References 94 publications

Center-driven and Clinically Driven Variation in US Liver Transplant Maintenance Immunosuppression Therapy: A National Practice Patterns Analysis

Center-driven and Clinically Driven Variation in US Liver Transplant Maintenance Immunosuppression Therapy: A National Practice Patterns Analysis

Acute rejection in vascularized composite allotransplantation

Rabbit antithymocyte globulin induction and risk of post-transplant lymphoproliferative disease in adult and pediatric solid organ transplantation: An update

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