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      Recipient Outcomes after ABO-Incompatible Liver Transplantation: A Systematic Review and Meta-Analysis

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          Abstract

          Background

          ABO-incompatible live transplantation (ILT) is not occasionally performed due to a relative high risk of graft failure. Knowledge of both graft and patient survival rate after ILT is essential for donor selection and therapeutic strategy. We systematically reviewed studies containing outcomes after ILT compared to that after ABO-compatible liver transplantation (CLT).

          Methodology/Principal Findings

          We carried out a comprehensive search strategy on MEDLINE (1966–July 2010), EMBASE (1980–July 2010), Biosis Preview (1969–July 2010), Science Citation Index (1981–July 2010), Cochrane Database of Systematic Reviews (Cochrane Library, issue 7, 2010) and the National Institute of Health (July 2010). Two reviewers independently assessed the quality of each study and abstracted outcome data. Fourteen eligible studies were included which came from various medical centers all over the world. Meta-analysis results showed that no significantly statistical difference was found in pediatric graft survival rate, pediatric and adult patient survival rate between ILT and CLT group. In adult subgroup, the graft survival rate after ILT was significantly lower than that after CLT. The value of totally pooled OR was 0.64 (0.55, 0.74), 0.92 (0.62, 1.38) for graft survival rate and patient survival rate respectively. The whole complication incidence (including acute rejection and biliary complication) after ILT was higher than that after CLT, as the value of totally pooled OR was 3.02 (1.33, 6.85). Similarly, in acute rejection subgroup, the value of OR was 2.02 (1.01, 4.02). However, it was 4.08 (0.90, 18.51) in biliary complication subgroup.

          Conclusions/Significance

          In our view, pediatric ILT has not been a contraindication anymore due to a similar graft and patient survival rate between ILT and CLT group. Though adult graft survival rate is not so satisfactory, ILT is undoubtedly life-saving under exigent condition. Most studies included in our analysis are observational researches. Larger scale of researches and Randomized-Control Studies are still needed.

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          Most cited references27

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          Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta-analyses.

          D Moher, D J Cook, S. Eastwood … (1999)
          The Quality of Reporting of Meta-analyses (QUOROM) conference was convened to address standards for improving the quality of reporting of meta-analyses of clinical randomised controlled trials (RCTs). The QUOROM group consisted of 30 clinical epidemiologists, clinicians, statisticians, editors, and researchers. In conference, the group was asked to identify items they thought should be included in a checklist of standards. Whenever possible, checklist items were guided by research evidence suggesting that failure to adhere to the item proposed could lead to biased results. A modified Delphi technique was used in assessing candidate items. The conference resulted in the QUOROM statement, a checklist, and a flow diagram. The checklist describes our preferred way to present the abstract, introduction, methods, results, and discussion sections of a report of a meta-analysis. It is organised into 21 headings and subheadings regarding searches, selection, validity assessment, data abstraction, study characteristics, and quantitative data synthesis, and in the results with "trial flow", study characteristics, and quantitative data synthesis; research documentation was identified for eight of the 18 items. The flow diagram provides information about both the numbers of RCTs identified, included, and excluded and the reasons for exclusion of trials. We hope this report will generate further thought about ways to improve the quality of reports of meta-analyses of RCTs and that interested readers, reviewers, researchers, and editors will use the QUOROM statement and generate ideas for its improvement.
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            A note on graphical presentation of estimated odds ratios from several clinical trials.

            R. F. GALBRAITH (1988)
            To display a number of estimates of a parameter obtained from different studies it is common practice to plot a sequence of confidence intervals. This can be useful but is often unsatisfactory. An alternative display is suggested which represents intervals as points on a bivariate graph, and which has advantages. When the data are estimates of odds ratios from studies with a binary response, it is argued that for either type of plot, a log scale should be used rather than a linear scale.
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              Rituximab and intravenous immunoglobulin treatment of chronic antibody-mediated kidney allograft rejection.

              Barbara Rüsi, Andreas Fischer, Thomas Fehr … (2009)
              Kidney transplant rejections are classified into T-cell-mediated and antibody-mediated rejections (AMR). C4d staining on allograft biopsies and solid-phase assays to measure donor-specific alloantibodies have helped to precisely define the latter. Although for acute AMRs, therapy mainly relies on plasmapheresis or immunoadsorption, no studies for treatment of chronic AMR are available. Here, we report on four kidney allograft recipients suffering from chronic AMR 1 to 27 years posttransplant, who were treated with a combination of rituximab and intravenous immunoglobulin (IVIG). Rituximab/IVIG improved kidney allograft function in all four patients, whereas donor-specific antibodies were reduced in 2 of 4 patients. However, in one patient an acute rejection episode occurred 12 months after this treatment, and another patient had severe, possibly rituximab-associated lung toxicity. Thus, rituximab/IVIG may be a useful strategy for the treatment of chronic AMR, but further randomized multicenter studies are necessary to establish its efficacy and safety profile.
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                Author and article information

                Contributors
                : Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, USA )
                ISSN (Electronic): 1932-6203
                Publication date Collection: 2011
                Publication date (Electronic): 25 January 2011
                Volume: 6
                Issue: 1
                Electronic Location Identifier: e16521
                Affiliations
                [1 ]Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
                [2 ]Key Laboratory of Organ Transplantation, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
                [3 ]Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
                University of California Los Angeles, United States
                Author notes

                Conceived and designed the experiments: JW SYY LZ SSZ. Performed the experiments: JW SYY SSZ LZ HYX XFX. Analyzed the data: JW SYY LZ SSZ. Contributed reagents/materials/analysis tools: JW SYY HYX LZ XFX. Wrote the paper: JW SYY LZ SSZ.

                Article
                Publisher ID: PONE-D-10-00579
                DOI: 10.1371/journal.pone.0016521
                PMC ID: 3026838
                PubMed ID: 21283553
                SO-VID: 78f32eda-e852-4ee5-bd03-8f1de5b03168
                Copyright © Wu et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
                History
                Date received : 10 August 2010
                Date accepted : 29 December 2010
                Page count
                Pages: 10
                Categories
                Subject: Research Article
                Subject: Medicine
                Subject: Clinical Research Design
                Subject: Meta-Analyses
                Subject: Systematic Reviews
                Subject: Gastroenterology and Hepatology
                Subject: Liver Diseases
                Subject: Acute Liver Failure
                Subject: Cirrhosis
                Subject: Portal Hypertension
                Subject: Surgery
                Subject: Gastrointestinal Surgery
                Subject: General Surgery
                Subject: Pediatric Surgery
                Subject: Transplant Surgery

                ScienceOpen disciplines: Uncategorized
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                ScienceOpen disciplines: Uncategorized

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