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Antibody induction therapy for lung transplant recipients
| Content Provider | Scilit |
|---|---|
| Author | Penninga, Luit Møller, Christian H. Penninga, Elisabeth I. Iversen, Martin Gluud, Christian Steinbrüchel, Daniel A. |
| Copyright Year | 2013 |
| Description | Journal: Cochrane Database of Systematic Reviews |
| Abstract | Lung transplantation has become a valuable and well‐accepted treatment option for most end‐stage lung diseases. Lung transplant recipients are at risk of transplanted organ rejection, and life‐long immunosuppression is necessary. Clear evidence is essential to identify an optimal, safe and effective immunosuppressive treatment strategy for lung transplant recipients. Consensus has not yet been achieved concerning use of immunosuppressive antibodies against T‐cells for induction following lung transplantation. We aimed to assess the benefits and harms of immunosuppressive T‐cell antibody induction with ATG, ALG, IL‐2RA, alemtuzumab, or muromonab‐CD3 for lung transplant recipients. We searched the Cochrane Renal Group's Specialised Register to 4 March 2013 through contact with the Trials Search Co‐ordinator using search terms relevant to this review. Studies contained in the Specialised Register are identified through search strategies specifically designed for CENTRAL, MEDLINE and EMBASE. We included all randomised controlled trials (RCTs) that compared immunosuppressive monoclonal and polyclonal T‐cell antibody induction for lung transplant recipients. An inclusion criterion was that all participants must have received the same maintenance immunosuppressive therapy within each study. Three authors extracted data. We derived risk ratios (RR) for dichotomous data and mean differences (MD) for continuous data with 95% confidence intervals (CI). Methodological risk of bias was assessed using the Cochrane risk of bias tool and trial sequential analyses were undertaken to assess the risk of random errors (play of chance). Our review included six RCTs (representing a total of 278 adult lung transplant recipients) that assessed the use of T‐cell antibody induction. Evaluation of the included studies found all to be at high risk of bias. We conducted comparisons of polyclonal or monoclonal T‐cell antibody induction versus no induction (3 studies, 140 participants); polyclonal T‐cell antibody versus no induction (3 studies, 125 participants); interleukin‐2 receptor antagonists (IL‐2RA) versus no induction (1 study, 25 participants); polyclonal T‐cell antibody versus muromonab‐CD3 (1 study, 64 participants); and polyclonal T‐cell antibody versus IL‐2RA (3 studies, 100 participants). Overall we found no significant differences among interventions in terms of mortality, acute rejection, adverse effects, infection, pneumonia, cytomegalovirus infection, bronchiolitis obliterans syndrome, post‐transplantation lymphoproliferative disease, or cancer. We found a significant outcome difference in one study that compared antithymocyte globulin versus muromonab‐CD3 relating to adverse events (25/34 (74%) versus 12/30 (40%); RR 1.84, 95% CI 1.13 to 2.98). This suggested that antithymocyte globulin increased occurrence of adverse events. However, trial sequential analysis found that the required information size had not been... |
| Related Links | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6486205/pdf http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008927.pub2/pdf |
| ISSN | 1469493X |
| e-ISSN | 14651858 |
| DOI | 10.1002/14651858.CD008927.pub2 |
| Journal | Cochrane Database of Systematic Reviews |
| Issue Number | 11 |
| Volume Number | 2013 |
| Language | English |
| Publisher | Wiley-Blackwell |
| Publisher Date | 2013-11-27 |
| Access Restriction | Open |
| Subject Keyword | Journal: Cochrane Database of Systematic Reviews Lung Transplantation Antibodies, Monoclonal Antibodies, Monoclonal/therapeutic Use Antibodies, Monoclonal, Humanized Antibodies, Monoclonal, Humanized/therapeutic Use Antilymphocyte Serum Antilymphocyte Serum/therapeutic Use Graft Rejection/immunology Graft Rejection/prevention & Control Immunoglobulin G/therapeutic Use Immunosuppression Immunosuppression/adverse Effects Immunosuppression/methods Immunosuppressive Agents Immunosuppressive Agents/adverse Effects |
| Content Type | Text |
| Resource Type | Article |
