Abstract
What is the issue? A kidney transplant is the best treatment for many people who have severe kidney disease to allow patients to return to work and feel better. Patients who receive a kidney transplant receive drugs to prevent their own body from rejecting the transplant ‐ the aim of treatment is to prolong the function of the kidney transplant while minimising common long‐term side effects of treatment such as cancer, infection, and diabetes. For some patients who have a much higher risk of rejection, additional treatment is given at the time of the operation (which may lower the body's ability to attack the kidney transplant and increase kidney function but can increase the risk of complications such as infection and cancer).
What did we do? We searched the Cochrane Kidney and Transplant's Specialised Register to 29 August 2016 for randomised controlled trials (RCTs) comparing monoclonal or polyclonal antibodies with placebo, no treatment, or other antibody therapy in adults and children who had received a kidney transplant.
What did we find? We identified 99 studies (265 records; 8956 participants; 33 with contemporary agents). From the available studies in this area, an antibody against human immune cells (ATG) reduces the chances of a patient having a kidney rejection by one‐third, but it is uncertain whether this prolongs the function of the kidney transplant or survival for the patient. ATG significantly increases viral infections including cytomegalovirus. In addition, the effects of ATG treatment on cancer are not well understood. Alemtuzumab is another treatment which has been compared to ATG in patients who have received less or no steroid therapy as part of their transplant treatment. Treatment with alemtuzumab with lower steroid doses or no steroid treatment at all may lower a patient's risk of kidney rejection within a year after transplantation when compared to ATG but overall the information about treatment benefits and harms of alemtuzumab in many clinical situations are not certain. This means we are not confident about the effects of alemtuzumab on kidney function, patient survival or treatment side‐effects.
Conclusions: Overall the available research on antibody treatment for kidney transplantation is limited when clinicians and patients make joint decisions about antibody therapy at the time of a kidney transplant because of the uncertain long term benefits and hazards of these treatments.