Work

Peri-transplant eculizumab for preventing antibody-mediated rejection in kidney transplant recipients at high immunologic risk: a systematic review with design-stratified evidence synthesis

Year: 2026

Type: review

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.

Source: Frontiers in Immunology

DOI: 10.3389/fimmu.2026.1982870

Authors: Chengze Liang, Rong Bao, Saifu Yin, Turun Song, Tao Lin

Institutions: Sichuan University, West China Medical Center of Sichuan University, West China Hospital of Sichuan University

Language: English

Topic: Renal Transplantation Outcomes and Treatments

Subfield: Transplantation

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801