Transplant Trial Watch

Positive Luminex and negative flow cytometry in kidney transplantation: a systematic review and meta-analysis.

Buttigieg, J., Ali, H. et al.

Nephrology Dialysis Transplantation, 2018; [record in progress]


Aims
To assess graft function, acute rejection (AR) rates, graft survival and patient survival in positive Luminex and negative flow cytometry (PLNF) compared with donor-specific antibody (DSA)-negative transplants.

Interventions
The PubMed, Ovid MEDLINE and Scopus database were searched in this study (01 January 2000 and 31 December 2016). Transplant characteristics such as Luminex cut-off intensity, FCXM cut-off, desensitization techniques, induction and maintenance immunosuppression, and outcomes such as graft function, AR episodes, graft survival and patient survival were utilised to generate a pooled analysis. Articles were only included if published in the English language. Publication bias was estimated using funnel plots.

Participants
1124 records were identified by the database search. After screening and eligibility assessment, 7 studies were included in the final content analysis (429 PLNF transplants and 10677 DSA-negative transplants).

Outcomes
Outcomes compared incidence of AR at 1 year, graft failure and patient mortality at 1 and 5 years between PLNF and DSA-negative transplants.

Follow-up
5 years

CET Conclusions
The systematic review aimed to compare glomerular filtration rate (GFR), acute rejection, and graft and patient survival for positive Luminex and negative flow (PLNF) cytometry transplants with donor-specific antibodies (DSA)-negative transplants. The bibliographic search identified 496 unique references of which seven studies met the inclusion criteria. Full text screening and data extraction was done by two independent reviewers. The methodological quality was assessed using the Newcastle-Ottawa scale although it was not described whether the quality assessment was done by two independent reviewers. Six out of seven studies were considered to be of good quality. Data were summarised by narrative review or, where possible, by calculating the risk ratios using a random effects model. Data allowed pooling of studies for acute rejection, and patient and graft survival and found no significant differences between PLNF and DSA-negative transplants for any of the outcomes. It should be noted that the pooled analyses only included two, three or four studies. Four studies reported GFR data and narrative review of the studies did not show a clear trend favouring PLNF or DSA-negative transplants.

Trial registration
None

Funding source
Not reported