中华医学杂志（英文版）2009，Vol.122Issue(14)：1692-1698,7.DOI:10.3760/cma.j.issn.0366-6999.2009.14.016
Efficacy and safety of induction therapy with alemtuzumab in kidney transplantation: a meta-analysis
Efficacy and safety of induction therapy with alemtuzumab in kidney transplantation: a meta-analysis
SHOU Zhang-fei 1ZHOU Qin 2CAI Jie-ru 2CHENG Jun 2HE Qiang 2WU Jian-yong 3CHEN Jiang-hua3
作者信息
- 1. Kidney Diseases Center,First Affiliated Hospital,Zhejiang University School of Medicine Hangzhou,Zhejiang 310003,China
- 2. Key Laboratory of Multi-organ Combined Transplantation,Ministry of Health,China Hangzhou,Zhejiang 310003,China
- 3. Kidney Diseases Center,First Affiliated Hospital,Zhejiang University School of Medicine Hangzhou,Zhejiang 310003,China
- 折叠
摘要
Abstract
Background Alemtuzumab, a humanized CD52 monoclonal antibody, with its profound lymphocyte depletion property, was expected to be a promising induction therapy agent for kidney transplantation (KTx). However, currently no consensus is available about its efficacy and safety. The aim of this meta-anaiysis was to make a profound review and an objective appraisal of this issue. Methods Relevant papers were searched, essentially in the PubMed database and the Cochrane library. After a thorough review, randomized controlled trials (RCTs) comparing the outcome of KTx using alemtuzumab induction therapy (test group) with a control group were collected according to the inclusion criteria. Data of general characteristic of studies and major outcomes of Ktx were extracted and meta-analyses were performed with RevMan 4.2 software. The odds ratio (OR) with a 95% confidence intervals (CI) was the principle measurement of effect. Results Five RCTs were included. The chi square test showed no significant between-study heterogeneity, thus fixed effect model was employed. Sub-group analysis with studies including alemtuzumab induction followed by a tacrolimus-based immunosuppressive regimen showed that the acute rejection rate (ARR) was lower relative to the control (OR=0.59, 95% CI 0.34-1.01, P=0.05). However, meta-analysis with all included studies revealed that neither ARR nor patient/graft survival rates differ significantly between the test and the control group, but the cytomegalovirus (CMV) infection rate was higher in the test group (OR 2.50, 95% CI 1.22-5.12, P=0.01 ). A great number of the test group recipients safely remained on a regimen that was steroid-free and with a reduced dose of conventional immunosuppressive drugs. Conclusions Alemtuzumab induction therapy for KTx was an effective and safe protocol in the tested follow-up period. Steroid avoidance and a dose reduction of conventional immunosuppressive drugs after alemtuzumab induction therapy may have clinical importance. However, high quality RCTs with larger population and longer follow-up are needed for a more accurate and objective appraisal of this novel protocol.关键词
alemtuzumab/kidney transplantation/efficacy/safety/meta-analysisKey words
alemtuzumab/kidney transplantation/efficacy/safety/meta-analysis分类
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SHOU Zhang-fei,ZHOU Qin,CAI Jie-ru,CHENG Jun,HE Qiang,WU Jian-yong,CHEN Jiang-hua..Efficacy and safety of induction therapy with alemtuzumab in kidney transplantation: a meta-analysis[J].中华医学杂志（英文版）,2009,122(14):1692-1698,7.
