Preconditioning Therapy in ABO-Incompatible Living Kidney Transplantation: A Systematic Review and Meta-Analysis.
Lo P, Sharma A, et al.Transplantation 2016; 100(4): 933-942.
Aims
To conduct a systematic review of published literature on the effects of any form of preconditioning therapies in living donor ABO incompatible (ABOi) kidney transplantation on graft and patient outcomes.
Interventions
Comprehensive literature searches were conducted using MEDLINE , Embase and ClinicalTrials.gov from inception to June 2015, to identify studies that documented the use and outcomes of preconditioning therapies in living donor ABOi kidney transplantation.
Participants
83 studies were included in the review comprising of case reports, cohort studies, registry studies and case controls.
Outcomes
The primary outcomes were graft and patient survival. Other long term outcomes included malignancy.
Follow-up
28 months
CET Conclusions
This systematic review did not identify any randomised controlled trials in the field of interest; the majority of included studies were case series or cohort studies. The paper describes several pre-conditioning techniques, including B-Cell Depletion, Blood Purification, Splenectomy, Apheresis, Immunoadsorption. It was not possible to provide a comparative effect between the different interventions. Overall the graft and patient survival in the included trials of ABO incompatible transplants was good. Unsurprisingly, there was evidence that more recently transplanted patients achieved better outcomes than previous patients. There was great variability in the follow up of the included studies so data on infective and later complications, such as malignancy, were not available.
Quality notes
Quality Assessment not appropriate.
Trial registration
None