The Treatment of Antibody-Mediated Rejection in Kidney Transplantation with recent drugs: A Network Meta-Analysis

초록

Method: Studies on antibody medated rejection(AMR) treatment were divided into four groups:, 1) rituximab, 2 bortezomib, 3 eculizumab, and 4) tocilizumab. We searched the CENTRAL, MEDLINE, EMBASE, and Science Citation Index Expanded databases from 1970 to February 2023.5 . We performed direct and indirect network meta-analyses using Bayesian models and ranked different AMR treatment method using a generation mixed treatment comparison (GeMTC) and Stata version 13. The outcomes included patient survival, graft failure, and bacterial and viral infections Results: This analysis included 21 clinical trials with a total of 1217 participants. We focused on graft failure events based on the use of four groups of medications when patients received induction therapy for AMR treatment. There was a lower tendency in graft failure rates in the bortezomib and tocilizumab groups (odds ratio [OR] 0.31, 95% CrI: 0.058-1.4 and OR 0.42, 95% CrI 0.012-7.4), while the eculizumab group showed a higher graft failure rate (OR 2.3, 95% CrI 0.26-31.0) compared to the rituximab using group. However, these study results were not statistically significant. Conclusion: When looking at the study results, although not statistically significant, it was observed that bortezomib and tocilizumab, compared to rituximab, showed a tendency to reduce the incidence of graft failure after AMR occurrence. Although this study did not demonstrate statistical significance, it is believed that future research with increased enrollment and additional studies may help identify effective drugs for AMR treatment.