title: Alemtuzumab induction in renal transplantation: a meta-analysis and systemic review.
abstract: OBJECTIVE
  To compare the efficacy and safety of alemtuzumab versus traditional antibodies for induction therapy in renal transplantation.
  
  
  METHODS
  Literature searches for all randomized controlled trials comparing alemtuzumab with traditional antibodies for post renal transplant induction therapy were performed using MEDLINE, EMBASE and the Cochrane Library. Quality assessment was performed in each trial. Meta-analyses were performed to demonstrate the pooled effects of relative risk (RR) with 95% confidence intervals (CI).
  
  
  RESULTS
  A total of 808 participants from six randomized controlled trials (RCTs) were included. Alemtuzumab was associated with lower incidence of biopsy-proven acute rejection over traditional antibodies (RR 0.63, CI 0.45-0.87, p=0.005). This difference remained when only studies comparing alemtuzumab with rabbit antithymocyte globulin were included (RR 0.32, CI 0.11-0.91, p=0.03), but lost significance when only patients at high-risk were included (RR 0.86, CI 0.48-1.55, p=0.62). No significant differences were detected between alemtuzumab and traditional antibodies in terms of delayed graft function, patient death, graft loss, and safety profile.
  
  
  CONCLUSIONS
  Alemtuzumab induction is superior to traditional antibodies in preventing AR in renal transplantation, but this benefit may not extend to recipients at high immunologic risk. The lower rejection rates do not translate into a uniform increase in graft or patient survival.
authors.affiliation: Department of Organ Transplantation, Changzheng Hospital, Shanghai 200003, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Zhang
authors.forename: Hejing
authors.initials: H
authors.lastname: Huang
authors.forename: Shu
authors.initials: S
authors.lastname: Han
authors.forename: Shangxi
authors.initials: S
authors.lastname: Fu
authors.forename: Liming
authors.initials: L
authors.lastname: Wang
mesh_terms: D000208:Acute Disease; D000074323:Alemtuzumab; D000818:Animals; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D015703:Antigens, CD / Q000276:immunology; D000951:Antigens, Neoplasm / Q000276:immunology; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D000074301:CD52 Antigen; D006023:Glycoproteins / Q000276:immunology; D006084:Graft Rejection / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007108:Immune Tolerance / Q000187:drug effects; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation; D011183:Postoperative Complications / Q000517:prevention & control*; D011817:Rabbits; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D015703:Antigens, CD; D000951:Antigens, Neoplasm; D000961:Antilymphocyte Serum; D000074301:CD52 Antigen; C000613862:CD52 protein, human; D006023:Glycoproteins; D007166:Immunosuppressive Agents; D000074323:Alemtuzumab