Li K H C, Ho J C S, Recaldin B, Gong M, Ho J, Li G, Liu T, Wu W K K, Wong M C S, Xia Y, Dong M, Tse G
Faculty of Medicine, Newcastle University, Newcastle Upon Tyne, United Kingdom; Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.
Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.
Transplant Proc. 2018 Dec;50(10):3723-3731. doi: 10.1016/j.transproceed.2018.08.044. Epub 2018 Sep 7.
Heart and lung transplantation is a high-risk procedure requiring intensive immunosuppressive therapy for preventing organ rejection. Alemtuzumab, a CD52-specific monoclonal antibody, is increasingly used for induction therapy compared with conventional agents. However, there has been no systematic review comparing its efficacy with traditional therapeutic drugs.
PubMed and EMBASE were searched to October 1, 2017, for articles on alemtuzumab in cardiothoracic transplant surgery. Of the 433 studies retrieved, 8 were included in the final meta-analysis.
In lung transplantation, alemtuzumab use was associated with lower odds of acute cellular rejection compared with antithymocyte globulin (odds ratio [OR], 0.21; 95% CI, 0.11-0.40; P < .001), lower acute rejection rates (OR, 0.12; 95% CI, 0.03-0.55; P < .01), and infection rates (OR, 0.69; 95% CI, 0.35-1.36; P = .33) when compared with basiliximab. Multivariate meta-regression analysis found that mean age, male sex, single lung transplant, double lung transplant, cytomegalovirus or Epstein-Barr virus status, idiopathic pulmonary fibrosis, cystic fibrosis, and mean ischemic time did not significantly influence acute rejection outcomes. For heart transplantation, alemtuzumab use was associated with lower acute rejection rates when compared with tacrolimus (OR, 0.44; 95% CI, 0.30-0.66; P < .001).
Alemtuzumab use was associated with lower rejection rates when compared with conventional induction therapy agents (antithymocyte globulin, basiliximab, and tacrolimus) in heart and lung transplantation. However, this was based on observational studies. Randomized controlled trials are needed to verify its clinical use.
心肺移植是一种高风险手术，需要强化免疫抑制治疗以预防器官排斥反应。与传统药物相比，阿仑单抗（一种抗CD52特异性单克隆抗体）越来越多地用于诱导治疗。然而，尚无系统评价比较其与传统治疗药物的疗效。
检索至2017年10月1日的PubMed和EMBASE数据库，查找有关阿仑单抗在心胸移植手术中的文章。在检索到的433项研究中，8项被纳入最终的荟萃分析。
在肺移植中，与抗胸腺细胞球蛋白相比，使用阿仑单抗与急性细胞排斥反应的较低几率相关（比值比[OR]，0.21；95%可信区间[CI]，0.11 - 0.40；P <.001），与巴利昔单抗相比，急性排斥反应率较低（OR，0.12；95%CI，0.03 - 0.55；P <.01），感染率较低（OR，0.69；95%CI，0.35 - 1.36；P =.33）。多变量荟萃回归分析发现，平均年龄、男性、单肺移植、双肺移植、巨细胞病毒或EB病毒状态、特发性肺纤维化、囊性纤维化以及平均缺血时间对急性排斥反应结局无显著影响。对于心脏移植，与他克莫司相比，使用阿仑单抗与较低的急性排斥反应率相关（OR，0.44；95%CI，0.30 - 0.66；P <.001）。
在心肺移植中，与传统诱导治疗药物（抗胸腺细胞球蛋白、巴利昔单抗和他克莫司）相比，使用阿仑单抗与较低的排斥反应率相关。然而，这是基于观察性研究。需要进行随机对照试验来验证其临床应用。
