Peri-transplant eculizumab for preventing antibody-mediated rejection in kidney transplant recipients at high immunologic risk: a systematic review with design-stratified evidence synthesis
4 affiliations
- 1Department of Urology/Institute of Urology, West China Hospital, Sichuan University
- 2West China Medical School, Sichuan University
- 3Kidney Transplantation Center, West China Hospital, Sichuan University
- 4Organ Transplantation Center, West China Hospital, Sichuan University
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.
Methods: 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.
Results: 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.
Discussion: 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).
Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/ , identifier CRD420261484542.
Related
- Virologic and Exploratory Immunologic Characterization of Relapsing Human Cytomegalovirus (HCMV) DNAemia in Solid Organ Transplant Recipients: A Prospective Observational Cohort Study
- Association of eplet mismatch load and allograft injury in kidney transplant recipients
- The Tell-Tale Heart ― Persistent Immune Activation in Histologically Rejection-Free Heart Transplant Recipients ―
- Retrospective evaluation of predictors and clinical impact of postoperative delirium in liver transplant recipients
- Clinicopathologic Features and Diagnostic Challenges of Mycophenolate Mofetil-Associated Enterocolitis in Lung Transplant Recipients
BibTeX
@article{liang2026peritransplant,
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}},
author = {Chengze Liang and Rong Bao and Saifu Yin and Turun Song and Tao Lin},
journal = {Frontiers in Immunology},
year = {2026},
month = oct,
doi = {10.3389/fimmu.2026.1982870},
url = {https://www.frontiersin.org/articles/10.3389/fimmu.2026.1982870/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Peri-transplant eculizumab for preventing antibody-mediated rejection in kidney transplant recipients at high immunologic risk: a systematic review with design-stratified evidence synthesis
AU - Chengze Liang
AU - Rong Bao
AU - Saifu Yin
AU - Turun Song
AU - Tao Lin
PY - 2026
DA - 2026/10/20
JO - Frontiers in Immunology
DO - 10.3389/fimmu.2026.1982870
UR - https://www.frontiersin.org/articles/10.3389/fimmu.2026.1982870/full
AB - 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. Methods: 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. Results: 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. Discussion: 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). Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/ , identifier CRD420261484542.
SN - 1664-3224
ER -