Summary of controlled trials from a systematic review assessing treatment strategies for ABMR¹

Refs.	ABMR definition	Trial design and intervention (N)	Patients with hemodialysis dependency or graft loss (intervention vs. control)
Böhmig et al (123)	Banff 1997	Stratified RCT; 9–14 sessions of immunoadsorption (protein A)	Treatment benefit observed:
			0 vs. 4 at 3 weeks
			ARR = 0.8 (95% CI, 0.2–0.9)
Blake et al (124)	Vascular	Stratified RCT; 5 PP treatments	No treatment benefit:
			4 vs. 6 at 6 months; RRR = 0.3 (95% CI, 0.001–0.8)
			10 vs. 13 at 5 years; RRR = 0.2 (95% CI, 0.001–0.5)
Bonomini et al (125)	Vascular, MP-resistant	RCT; 3–7 PP treatments	Treatment benefit observed:
			7 vs. 17 at 2 weeks; RRR = 0.6 (95% CI, 0.3–0.8)
Kirubakaran et al (126)	Vascular	RCT; 8 PP treatments	Trend to harm:
			6 vs. 3 at 1 month; RRI = 0.5 (95% CI, 0.001–0.8)
Allen et al (127)	Vascular, MP-resistant	RCT; 6 PP treatments	No treatment benefit (trend to harm at 220 days):
			3 vs. 4 at 6 days; RRR = 0.2 (95% CI, 0.001–0.8)
			11 vs. 9 at 220 days; RRI = 0.2 (95% CI, 0.001–0.5)
Franco et al (128)	Vascular, MP-resistant	Historical control; 6 PP treatments	Treatment benefit observed:
			6 vs. 13 at 3 months; OR = 0.4 (95% CI, 0.1–1.3)
Lefaucheur et al (129)	Banff 1997	Historical control; 4 PP treatments; 2 rituximab doses	Treatment benefit observed:
			1 vs. 6 at 3 years; OR = 0.1 (95% CI, 0.008–0.9)
Kaposztas et al (130)	ALG-resistant	Historical control; rituximab	Treatment benefit observed:
			2 vs. 8 at 2 years; OR = 0.2 (95% CI, 0.04–1.09)
Vangelista et al (131)	Vascular, anti-HLA	Nonrandomized case-controlled; 4–5 PP treatments	Treatment benefit observed:
			1 vs. 3
Macaluso et al (132)	ABMR (no other details)	Nonrandomized, case-controlled; 4 doses of bortezomib, 1 dose of rituximab, 5 PP treatments	Treatment benefit observed:
			1 vs. 10 at 3 months; OR = 0.1 (95% CI, 0.01–0.9)
Loupy et al (45)	Vascular with DSA	Nonrandomized, case-controlled; OKT3 vs. IVIG vs. PP and rituximab	Treatment benefit observed for PP and rituximab:
			HR = 0.19 (vs. OKT3)
			HR = 0.11 (vs. IVIG)
Lubetzky (133)	With DSA	Nonrandomized, case-controlled; rituximab vs. bortezomib	Treatment benefit observed for bortezomib:
			3 vs. 1 at 6 months; OR = 5.3 (95% CI, 0.5–59.3)
Waiser et al (134)	With DSA	Historical cohort; 4 bortezomib doses vs. 1 rituximab dose, 6 PP treatments and 30 g IVIG	No treatment benefit:
			2 vs. 3 (at 6 months); OR = 0.5 (95% CI, 0.06–4.0)

ABMR, antibody-mediated rejection; ALG, antilymphocyte globulin; ARR, absolute risk reduction; CI, confidence interval; DSA, donor-specific antibodies; HR, hazard ratio; IVIG, intravenous immunoglobulin; MP, methylprednisolone; OR, odds ratio; PP, plasmapheresis; RCT, randomized controlled trial; RRI, relative risk increase; RRR, relative risk reduction; RRI, relative risk increase.

¹Table 1Adapted with permission from Roberts et al ¹²².