Shi Xinmiao, Han Wenke, Ding Jie
Department of Pediatrics Institute of Urology, Peking University Department of Urology, Peking University First Hospital, Beijing, China.
Medicine (Baltimore). 2017 Dec;96(49):e8899. doi: 10.1097/MD.0000000000008899.
Human leukocyte antigen (HLA) was important biological barrier to a successful transplantation. Quantitative evaluations of the effect of HLA mismatching on heart, liver, umbilical cord blood, and hematopoietic stem cell transplantation, have previously been reported. In new era of immunosuppression, the reported magnitude effect of HLA mismatching on survival outcomes of kidney transplantation was controversial. In addition, the current kidney allocation guideline recommendations in different countries were inconsistent in term of HLA mismatching. We undertake this study to conduct a systematic review and meta-analysis to assess the magnitude effect of HLA mismatching in adult kidney transplantation, with a particular focus on graft survival and mortality.
The present systematic review and meta-analysis protocol was conducted following the Meta-analysis of Observational Studies in Epidemiology protocol (MOOSE-P) and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol (PRISMA-P). PubMed, EMBASE, Cochrane library Database will be searched without language restriction. Studies fulfill the following criteria will be eligible: included study cohorts comprising adult recipients; reported the association between HLA mismatching (per mismatches or HLA-A, -B, -DR mismatches) and posttransplant survival outcomes; provided effect estimates of hazard ratios (HRs) with 95% confidence interval (CIs). The incidence of measured outcomes was defined according to the European Renal Best Practice Transplantation Guidelines and Kidney Disease: Improving Global Outcomes Guidelines.
This study will quantitatively assess the association of HLA per mismatches, DR-antigen mismatches, A-antigen mismatches, and B-antigen mismatches with survival outcomes of overall graft failure, death-censored graft failure, all-cause mortality, and mortality with a functioning graft.
This study will determine the issues on what extent HLA compatibility influenced recipient and graft survival and which HLA antigen plays a more important role in kidney transplantation.
PROSPERO CRD42017071894.
人类白细胞抗原（HLA）是成功移植的重要生物学障碍。此前已有关于HLA错配对心脏、肝脏、脐带血和造血干细胞移植影响的定量评估报道。在免疫抑制的新时代，HLA错配对肾移植生存结局的影响程度报道存在争议。此外，不同国家目前的肾脏分配指南在HLA错配方面的建议并不一致。我们开展本研究以进行系统评价和荟萃分析，评估HLA错配在成人肾移植中的影响程度，特别关注移植物存活和死亡率。
本系统评价和荟萃分析方案遵循流行病学观察性研究的荟萃分析方案（MOOSE-P）和系统评价与荟萃分析的首选报告项目方案（PRISMA-P）进行。将对PubMed、EMBASE、Cochrane图书馆数据库进行无语言限制的检索。符合以下标准的研究将纳入：纳入成年受者的研究队列；报告HLA错配（按错配数或HLA-A、-B、-DR错配）与移植后生存结局之间的关联；提供危险比（HR）及其95%置信区间（CI）的效应估计值。测量结局的发生率根据欧洲肾脏最佳实践移植指南和改善全球肾脏病预后组织指南进行定义。
本研究将定量评估每个HLA错配、DR抗原错配、A抗原错配和B抗原错配与总体移植物失败、死亡删失移植物失败、全因死亡率以及有功能移植物的死亡率等生存结局之间的关联。
本研究将确定HLA相容性在多大程度上影响受者和移植物存活以及哪种HLA抗原在肾移植中起更重要作用等问题。
PROSPERO CRD42017071894
