Chandramohan Deepak, Adisa Oluwadamilola, Patel Devansh, Ware Erin, Eleti Navya, Agarwal Gaurav
Department of Internal Medicine/Nephrology, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
Department of Internal Medicine, Louisiana State University, Shreveport, LA 71103, USA.
Life (Basel). 2024 Aug 10;14(8):998. doi: 10.3390/life14080998.
(1) Background: We aimed to investigate the outcomes of human leukocyte antigen (HLA)-incompatible transplantation for patients who received desensitization with intravenous immunoglobulins (IVIg), plasmapheresis, and rituximab. (2) Methods: A comprehensive search of multiple electronic databases to identify studies that utilized desensitization was conducted. The random-effects model was used to calculate the pooled rates and the 95% confidence interval (CI). (3) Results: A total of 1517 studies were initially identified. From these, 16 studies met the inclusion criteria, encompassing 459 patients, with a mean age of 45 years, of whom 40.8% were male. CDC crossmatch was positive in 68.3% (95% CI: 43.5-85.8; I2 87%), and 89.4% (95% CI: 53.4-98.4%; I2 89.8%) underwent living-donor transplantation. The 1-year graft survival pooled rate was 88.9% (95% CI: 84.8-92; I2 0%) and the 5-year graft survival rate was 86.1% (95% CI: 81.2-89.9; I2 0%). The 1-year patient survival rate was 94.2% (95% CI: 91-96.3; I2 0%), and the 5-year patient survival rate was 88.9% (95% CI: 83.5-92.7%; I2 7.7%). The rate of antibody-mediated rejection was 37.7% (95% CI: 25-52.3; I2 80.3%), and the rate of acute cell-mediated rejection was 15.1% (95% CI: 9.1-24; I2 55%). (4) Conclusions: Graft and patient survival are favorable in highly sensitized patients who undergo desensitization using IVIg, plasmapheresis, and rituximab for HLA-incompatible transplantation.
（1）背景：我们旨在研究接受静脉注射免疫球蛋白（IVIg）、血浆置换和利妥昔单抗脱敏治疗的患者进行人类白细胞抗原（HLA）不相合移植的结果。（2）方法：对多个电子数据库进行全面检索，以识别使用脱敏治疗的研究。采用随机效应模型计算合并率和95%置信区间（CI）。（3）结果：最初共识别出1517项研究。其中，16项研究符合纳入标准，涉及459例患者，平均年龄45岁，其中40.8%为男性。CDC交叉配型阳性率为68.3%（95%CI：43.5 - 85.8；I2 87%），89.4%（95%CI：53.4 - 98.4%；I2 89.8%）的患者接受了活体供体移植。1年移植肾存活率合并率为88.9%（95%CI：84.8 - 92；I2 0%），5年移植肾存活率为86.1%（95%CI：81.2 - 89.9；I2 0%）。1年患者生存率为94.2%（95%CI：91 - 96.3；I2 0%），5年患者生存率为88.9%（95%CI：83.5 - 92.7%；I2 7.7%）。抗体介导的排斥反应发生率为37.7%（95%CI：25 - 52.3；I2 80.3%），急性细胞介导的排斥反应发生率为15.1%（95%CI：9.1 - 24；I2 55%）。（4）结论：对于接受IVIg、血浆置换和利妥昔单抗脱敏治疗以进行HLA不相合移植的高敏患者，移植肾和患者的存活率良好。
