Diagnostic Performance of Fas Ligand mRNA Expression for Acute Rejection after Kidney Transplantation: A Systematic Review and Meta-Analysis.
Heng B, Ding H, et al.PLoS ONE 2016; 11(11): e0165628.
Aims
To conduct a systematic review and meta-analysis in order to clarify the role of Fas ligand (FASL) in acute renal rejection.
Interventions
The databases MEDLINE, EMBASE and the Cochrane Library were searched until February 2016. Studies of which FASL messenger RNA (mRNA) expression was evaluated as a diagnostic marker for post-transplant acute rejection (AR) episodes, were identified for inclusion by two reviewers.
Participants
12 studies published between 1997 and 2008 comprising 496 subjects met the inclusion criteria and were included in the meta-analysis.
Outcomes
Outcomes measured included accuracy data for AR, the year of publication, area, sample source, quantitative techniques, housekeeping genes, fluorescence staining, sample collection time post-renal transplantation, and clinical classification of AR.
Follow-up
Variable: Those in which samples were collected within <6mo were extracted & independently analysed
CET Conclusions
This interesting paper attempts a systematic review and meta-analysis of the diagnostic performance of Fas-Ligand mRNA expression for acute rejection following renal transplantation. The authors identify 12 studies, and show an overall ROC AUC of 0.94 demonstrating good diagnostic performance. There are a number of important limitations to this analysis. The included studies are very heterogeneous, using a combination of blood, urine and tissue samples for measurement. No reference is made to the threshold values used to determine a positive test in each study, which likely varied. It is not clear whether the tests were conducted at the time of suspected rejection, or as protocol samples for predicting subsequent rejection. These issues mean that the ability of the test to diagnose or predict rejection remains uncertain. In particular, given that only 7 of the 12 included studies used non-invasive sample types, it is uncertain what Fas-L measurement can add over a standard diagnostic biopsy.
Quality notes
Quality assessment not appropriate
Trial registration
None