Polyclonal and monoclonal antibodies for induction therapy in kidney transplant recipients

Morgan, Penny; Cross, Nicholas B; Barnett, Nicholas; Craig, Jonathan C.; Webster, Angela C

doi:10.1002/14651858.cd004759

Cochrane Database of Systematic Reviews 2004

DOI: 10.1002/14651858.cd004759

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Polyclonal and monoclonal antibodies for induction therapy in kidney transplant recipients

Penny Morgan¹,

Nicholas B Cross²,

Nicholas Barnett³

et al.

Abstract: Trusted evidence. Informed decisions. Better health.

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2017

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Polyclonal and monoclonal antibodies for induction therapy in kidney transplant recipients

Hill

Cross

Barnett

et al. 2017

Cochrane Database of Systematic Reviews

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ATG reduces acute rejection but has uncertain effects on death, graft survival, malignancy and NODAT, and increases CMV infection, thrombocytopenia and leucopenia. Given a 45% acute rejection risk without ATG induction, seven patients would need treatment to prevent one having rejection, while incurring an additional patient experiencing CMV disease for every 12 treated. Excluding non-CNI studies, the risk of rejection was 37% without induction with six patients needing treatment to prevent one having rejection.In the context of steroid minimisation, alemtuzumab prevents acute rejection at 1 year compared to ATG. Eleven patients would require treatment with alemtuzumab to prevent 1 having rejection, assuming a 21% rejection risk with ATG.Triple maintenance without induction therapy compared to alemtuzumab combined with ESW had similar rates of acute rejection but adverse effects including NODAT were poorly documented. Alemtuzumab plus steroid withdrawal would cause one additional patient experiencing CMV disease for every six patients treated compared to no induction and triple maintenance, in the absence of any clinical benefit. Overall, ATG and alemtuzumab decrease acute rejection at a cost of increased CMV disease while patient-centred outcomes (reduced death or lower toxicity) do not appear to be improved.

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Polyclonal and monoclonal antibodies for induction therapy in kidney transplant recipients

Hill

Cross

Barnett

et al. 2017

Cochrane Database of Systematic Reviews

Self Cite

View full text Add to dashboard Cite

show abstract

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Polyclonal and monoclonal antibodies for induction therapy in kidney transplant recipients

Abstract: Trusted evidence. Informed decisions. Better health.

Cited by 1 publication

References 10 publications

Polyclonal and monoclonal antibodies for induction therapy in kidney transplant recipients

Polyclonal and monoclonal antibodies for induction therapy in kidney transplant recipients

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