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SYSTEMATIC REVIEW article

Front. Immunol.
Sec. Alloimmunity and Transplantation
Volume 15 - 2024 | doi: 10.3389/fimmu.2024.1451907

Network Meta-analysis of Pharmacological Treatment for Antibody-mediated Rejection after Organ Transplantation

Provisionally accepted
Junjie Sun Junjie Sun 1Yanqing Yu Yanqing Yu 1Fu Huang Fu Huang 1,2Qiuwen Zhang Qiuwen Zhang 1Lirong Zhu Lirong Zhu 1Guining He Guining He 1Haibin Li Haibin Li 1Xuyong Sun Xuyong Sun 1*
  • 1 Institute of Transplantation Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
  • 2 Second Affiliated Hospital of Guangxi Medical University, Nanning, China

The final, formatted version of the article will be published soon.

    Abstract Objective: This study aims to assess the efficacy of pharmacological interventions in mitigating graft injury in transplant patients with antibody-mediated rejection (AMR) through a network meta-analysis (NMA). Methods: A search was conducted on databases such as Cochrane Library, PubMed, EmBase, and Web of Science for randomized controlled trials (RCTs) on pharmacological interventions for alleviating graft injury following AMR. The search was performed for publications up to April 12, 2024. Two reviewers conducted independent reviews of the literature, extracted data, and assessed the risk of bias (ROB) in the included studies using the ROB assessment tool recommended by the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0. A Bayesian NMA was conducted using R 4.4.0, RStudio software, and the GeMTC package to assess the outcomes in estimated glomerular filtration rate (eGFR), mean fluorescence intensity (MFI), g-score, and infection under pharmacological treatments. Results: A total of 8 RCTs involving 215 patients and 6 different pharmacological treatments were included in this NMA. The results indicated that the increase in eGFR by eculizumab (SUCRA score: 81) appeared to be more promising. The decrease in MFI by bortezomib (SUCRA score: 72.3), rituximab (SUCRA score: 68.2), and clazakizumab (SUCRA score: 67.1) demonstrated better efficacy. The decrease in g-score by eculizumab (SUCRA score: 74.3), clazakizumab (SUCRA score: 72.2), and C1INH (SUCRA score: 63.6) appeared to have more likelihood. For infection reduction, clazakizumab (SUCRA score: 83.5) and bortezomib (SUCRA score: 66.8) might be better choices. Conclusion: The results of this study indicate that eculizumab has the potential to enhance eGFR and reduce g-score. Bortezomib demonstrates superior efficacy in reducing MFI. Clazakizumab appears to be more effective in reducing infections.

    Keywords: Antibody-mediated Rejection, Organ Transplantation, pharmacological treatments, Network meta-analysis, randomized controlled trials

    Received: 09 Sep 2024; Accepted: 26 Nov 2024.

    Copyright: © 2024 Sun, Yu, Huang, Zhang, Zhu, He, Li and Sun. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Xuyong Sun, Institute of Transplantation Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.