{
  "abstract": "Introduction: Highly sensitized candidates, preformed donor-specific antibodies, and ABO incompatibility restrict access to kidney transplantation and increase antibody-mediated rejection (AMR) risk. We systematically evaluated peri-transplant eculizumab-containing prophylaxis in high-immunologic-risk kidney transplantation.\n\nMethods: We searched PubMed, Europe PMC, Ovid Embase, Web of Science Core Collection, Ovid CENTRAL, ClinicalTrials.gov, WHO ICTRP, and supplementary sources; database searches ended 10 June 2026, and registry searches ended 20 August 2026.\n\nResults: A total of 31 reports were included; 30 were linked to 14 studies or registry projects, and one pathology report was retained qualitatively. In the only randomized trial, centrally confirmed AMR occurred in 5/51 recipients in both the eculizumab and standard-desensitization groups [risk ratio (RR) 1.00, 95% confidence interval (CI) 0.31–3.25]. A historical comparison reported AMR in 2/26 versus 21/51 recipients (RR 0.19, 95% CI 0.05–0.74), but treatment era, post-transplant plasma exchange, and clinical management changed concurrently. An 80-recipient single-arm study reported three AMR events by week 9. Long-term follow-up showed no consistent graft-survival or kidney-function advantage, while persistent donor-specific antibodies and chronic microvascular injury remained evident.\n\nDiscussion: Eculizumab can provide terminal complement blockade within selected combination prophylaxis, but randomized evidence does not establish an incremental reduction in AMR. Definitive trials require standardized background therapy, rescue criteria, long-term graft outcomes, and infection surveillance. This systematic review was registered in PROSPERO (CRD420261484542).\n\nSystematic review registration: https://www.crd.york.ac.uk/PROSPERO/ , identifier CRD420261484542.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Urology/Institute of Urology, West China Hospital, Sichuan University",
    "West China Medical School, Sichuan University",
    "Kidney Transplantation Center, West China Hospital, Sichuan University",
    "Organ Transplantation Center, West China Hospital, Sichuan University"
  ],
  "article_type": "systematic review",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0,
        1,
        2,
        3
      ],
      "name": "Chengze Liang"
    },
    {
      "affs": [
        0,
        1,
        2,
        3
      ],
      "name": "Rong Bao"
    },
    {
      "affs": [
        0,
        1,
        2,
        3
      ],
      "name": "Saifu Yin"
    },
    {
      "affs": [
        0,
        2,
        3
      ],
      "name": "Turun Song"
    },
    {
      "affs": [
        0,
        2,
        3
      ],
      "name": "Tao Lin"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/d1tx4wgez0fg2.bib",
  "cited_by": 0,
  "doi": "10.3389/fimmu.2026.1982870",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13727399/?tool=EBI",
  "id": "d1tx4wgez0fg2",
  "issns": [
    "1664-3224"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fimmu.2026.1982870/full",
  "language": "eng",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Systematic Review"
    ],
    [
      "openalex",
      "2747|Renal Transplantation Outcomes and Treatments"
    ]
  ],
  "openalex": "W7223043467",
  "pdf_url": "https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2026.1982870/pdf",
  "pmcid": "PMC13727399",
  "pmid": "42978583",
  "published": "2026-10-20",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/d1tx4wgez0fg2.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:17Z",
      "native_id": "10.3389/fimmu.2026.1982870",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fimmu.2026.1982870/full"
    },
    {
      "first_seen": "2026-11-04T15:20:46Z",
      "native_id": "PMC:PMC13727399",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13727399"
    },
    {
      "first_seen": "2026-11-06T12:23:17Z",
      "native_id": "PMC13727399",
      "source": "pmc",
      "url": "https://doi.org/10.3389/fimmu.2026.1982870"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2747|Renal Transplantation Outcomes and Treatments",
      "subfield": "surgery"
    }
  ],
  "title": "Peri-transplant eculizumab for preventing antibody-mediated rejection in kidney transplant recipients at high immunologic risk: a systematic review with design-stratified evidence synthesis",
  "title_text": "Peri-transplant eculizumab for preventing antibody-mediated rejection in kidney transplant recipients at high immunologic risk: a systematic review with design-stratified evidence synthesis",
  "type": "peer-reviewed",
  "updated_at": "2026-11-07T12:20:36Z",
  "url": "https://research.draconitic.com/paper/d1tx4wgez0fg2",
  "venue": "Frontiers in Immunology",
  "versions": []
}