Cochrane · systematic review · CD004756
Polyclonal and monoclonal antibodies for treating acute rejection episodes in kidney transplant recipients
Webster, AC, Wu, S, Tallapragada, K, et al. · Cochrane Database of Systematic Reviews · 2017 · Cochrane Library
Kidney and TransplantAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
26
current version
GRADE rated
26
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 0 · 0%Very low 5 · 19.2%Low 13 · 50%Moderate 7 · 26.9%High 1 · 3.8%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Antibody (T cell) versus steroid (stratified by antibody type) for the treatment of first rejection episodes in kidney transplant recipients
Population: kidney transplant recipients: first rejection episode
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Failure of reversal of acute rejection Antibody (T cell) vs steroid (stratified by antibody type) | RR 0.5 [0.3, 0.82] | 6 studies · 405 participants | Moderate Downgraded: risk of bias |
Recurrent rejection Antibody (T cell) vs steroid (stratified by antibody type) | RR 0.75 [0.56, 1] | 9 studies · 508 participants | Moderate Downgraded: risk of bias |
Graft loss or death with a functioning graft Antibody (T cell) vs steroid (stratified by antibody type) | RR 0.84 [0.58, 1.22] | 8 studies · 490 participants | Low Downgraded: risk of bias |
Graft loss censored for death Antibody (T cell) vs steroid (stratified by antibody type) | RR 0.8 [0.57, 1.12] | 8 studies · 475 participants | Low Downgraded: risk of bias |
Death Antibody (T cell) vs steroid (stratified by antibody type) | RR 0.98 [0.51, 1.88] | 7 studies · 413 participants | Very low Downgraded: risk of bias |
Treatment adverse events: fever, chill, or malaise after drug administration Antibody (T cell) vs steroid (stratified by antibody type) | RR 23.88 [5.1, 111.86] | 4 studies · 280 participants | Very low Downgraded: risk of bias |
Antibody (T cell) + steroid versus steroid alone for the treatment of first rejection episodes in kidney transplant recipients
Population: treatment of first rejection episodes in kidney transplant recipients: first rejection episode
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Failure of reversal of acute rejection episode Antibody (T cell) + steroid vs steroid alone | RR 0.42 [0.17, 1.01] | 1 study · 30 participants | Low Downgraded: imprecision |
Recurrent rejection Antibody (T cell) + steroid vs steroid alone | RR 0.07 [0, 1.06] | 1 study · 30 participants | Low Downgraded: imprecision |
Graft loss or death with a functioning graft Antibody (T cell) + steroid vs steroid alone | RR 0.35 [0.02, 5.14] | 2 studies · 52 participants | Very low Downgraded: imprecision |
Graft loss censored for death Antibody (T cell) + steroid vs steroid alone | RR 0.33 [0.03, 4.16] | 2 studies · 50 participants | Very low Downgraded: imprecision |
Death Antibody (T cell) + steroid vs steroid alone | RR 0.86 [0.53, 1.39] | 2 studies · 50 participants | Low Downgraded: imprecision |
Muromonab‐CD3 (T cell) versus other antibody (stratified by comparator) for the treatment of first rejection episodes in kidney transplant recipients
Population: kidney transplant recipients: first rejection episode
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Failure of acute rejection reversal Muromonab‐CD3 (T cell) vs other antibody (stratified by comparator) | RR 1.84 [0.92, 3.67] | 2 studies · 132 participants | Moderate Downgraded: imprecision |
Recurrent rejection Muromonab‐CD3 (T cell) vs other antibody (stratified by comparator) | RR 1.06 [0.59, 1.88] | 2 studies · 129 participants | Moderate Downgraded: imprecision |
Treatment adverse events: fever, chills, malaise after drug administration Muromonab‐CD3 (T cell) vs other antibody (stratified by comparator) | RR 3.12 [1.87, 5.21] | 2 studies · 132 participants | Low Downgraded: imprecision |
Treatment adverse events: neurological side effects Muromonab‐CD3 (T cell) vs other antibody (stratified by comparator) | RR 13.1 [1.43, 120.05] | 2 studies · 132 participants | Low Downgraded: imprecision |
Rituximab (B cell) + steroid versus steroid alone for the treatment of first rejection episodes in kidney transplant recipients
Population: kidney transplant recipients: first rejection episode
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Failure of reversal of acute rejection Rituximab (B cell) + steroid vs steroid alone | RR 0.94 [0.54, 1.64] | 2 studies · 53 participants | Moderate Downgraded: imprecision |
Graft loss or death with a functioning graft Rituximab (B cell) + steroid vs steroid alone | RR 1 [0.23, 4.35] | 2 studies · 58 participants | Moderate Downgraded: imprecision |
Death Rituximab (B cell) + steroid vs steroid alone | no estimate extracted | 2 studies · 58 participants | High |
Treatment adverse events: UTI/pyelonephritis Rituximab (B cell) + steroid vs steroid alone | RR 5.73 [1.8, 18.21] | 1 study · 38 participants | Moderate Downgraded: imprecision |
Antibody versus other antibody (stratified by antibody type) for the treatment of steroid‐resistant rejection episodes in kidney transplant recipients
Population: kidney transplant recipients: steroid‐resistant rejection episodes
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Failure of acute rejection reversal Antibody vs other antibody (stratified by antibody type) | RR 1.07 [0.63, 1.81] | 5 studies · 244 participants | Low |
Recurrent rejection Antibody vs other antibody (stratified by antibody type) | RR 0.78 [0.47, 1.28] | 5 studies · 284 participants | Low |
Graft loss censored for death Antibody vs other antibody (stratified by antibody type) | RR 0.86 [0.34, 2.17] | 5 studies · 244 participants | Low |
Graft loss or death with a functioning graft Antibody vs other antibody (stratified by antibody type) | RR 0.81 [0.43, 1.51] | 5 studies · 211 participants | Low |
Death Antibody vs other antibody (stratified by antibody type) | RR 0.39 [0.09, 1.65] | 3 studies · 175 participants | Low |
Treatment adverse events: fever, chills, malaise after drug administration Antibody vs other antibody (stratified by antibody type) | no estimate extracted | NR | Low |
Treatment adverse events: bacterial infection Antibody vs other antibody (stratified by antibody type) | RR 8.64 [1.64, 45.56] | 2 studies · 109 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |