Table 1. Characteristics of the 37 included studies.
| First author (date of publication) | Population | Study type | Period of inclusion | Number of patients | Effect size (95% CI) |
|---|---|---|---|---|---|
| Wahrmann et al. (2009) [26] | Retrospective, single-center analysis of consecutive adult renal transplants selected based on the presence of pretransplant DSAs | Cohort | 2001–2002 | 338 | 2.40 (0.90–6.00) for graft loss 10.10 (3.20–31.00) for rejection |
| Hönger et al. (2010) [28] | Retrospective, single-center analysis of consecutive adult renal transplant recipients with low levels of pretransplant DSAs | Cohort | 1999–2004 | 64 | 0.93 (0.25–3.44) for rejection |
| Sutherland et al. (2011) [50] | Retrospective, single-center analysis of pediatric renal transplant recipients without DSAs at the time of transplantation | Cohort | 2000–2008 | 35 | 5.80 (1.40–22.90) for graft loss |
| Hönger et al. (2011) [51] | Retrospective, single-center analysis of adult renal transplant recipients with high levels of DSAs pre transplant; recipients who developed ABMR within 6 months | Cohort | 1999–2008 | 71 | 0.43 (0.17–1.12) for rejection |
| Smith et al. (2011) [7] | Retrospective, single-center analysis of living heart transplant recipients after 1 year of transplantation without DSAs pre transplant | Cohort | 1995–2004 | 243 | 3.02 (1.11–8.23) for graft loss |
| Kaneku et al. (2012) [52] | Retrospective (2-center) analysis of adult liver transplant recipients with liver biopsies showing chronic rejection and DSA analysis at the same time | Case- control |
NC | 39 | 3.35 (1.39–8.05) for graft loss |
| Bartel et al. (2013) [53] | Retrospective, single-center analysis of 68 desensitized renal recipients who had been subjected to peritransplant desensitization | Cohort | 1999–2008 | 68 | 10.10 (1.60–64.20) for rejection |
| Lawrence et al. (2013) [54] | Retrospective, single-center study of consecutive renal transplant recipients | Cohort | 2005–2010 | 52 | 8.90 (1.20–65.86) for rejection |
| Crespo et al. (2013) [55] | Retrospective (2-center) analysis of renal transplant patients with pretransplant DSAs | Cohort | 2006–2011 | 355 | 0.83 (0.17–4.14) for graft loss 1.44 (0.23–9.11) for rejection |
| Loupy et al. (2013) [16] | Consecutive adult patients in a retrospective (2-center) analysis; unselected global population with DSA detection before or after renal transplantation | Cohort | 2004–2010 | 1,016 | 4.78 (2.69–8.49) for graft loss |
| Freitas et al. (2013) [56] | Retrospective, single-center analysis of renal transplant recipients selected on the basis of DSA detection during follow-up | Cohort | 1999–2012 | 203 | 3.50 (1.30–9.50) for graft loss |
| Arnold et al. (2014) [57] | Retrospective, single-center analysis of renal transplant recipients without DSAs pre transplant and screened for de novo DSAs | Cohort | 1997–2007 | 274 | 4.81 (1.65–14.03) for graft loss |
| Smith et al. (2014) [25] | Retrospective, single-center analysis of lung transplant recipients with pretransplant DSA detection | Cohort | 1991–2003 | 63 | 6.43 (2.96–13.97) for graft loss |
| Everly et al. (2014) [58] | Retrospective, single-center analysis of primary renal transplant recipients without pretransplant DSA detection | Cohort | 1999–2006 | 179 | 2.48 (1.02–6.04) for graft loss |
| O’Leary et al. (2015) [24] | Retrospective, single-center analysis of consecutive patients with 1-year survival post liver transplantation; one group analyzed pretransplant DSA effects, and another group analyzed the impact of de novo DSAs |
Cohort | 2000–2009 | 1,270 | 1.90 (1.62–3.45) for C1q for graft loss 2.40 (1.82–5.75) for IgG3 for graft loss |
| Wozniak et al. (2015) [59] | Retrospective, single-center analysis of pediatric liver transplant patients who were either nontolerant, tolerant, or stable | Cohort | NC | 50 | 4.30 (1.10–16.40) for rejection |
| Khovanova et al. (2015) [60] | Retrospective, single-center analysis of HLA-incompatible desensitized renal transplant patients | Cohort | 2003–2012 | 80 | 1.69 (0.41–6.93) for preexisting DSAs for graft loss 2.09 (0.30–14.60) for preexisting and de novo DSAs for graft loss |
| Sicard et al. (2015) [17] | Retrospective analysis of consecutive (2-center) adult renal transplant patients who developed ABMR | Cohort | 2004–2012 | 69 | 2.80 (1.12–6.95) for C3d for graft loss 1.98 (0.95–4.14) for C1q for graft loss |
| Thammanichanond et al. (2016) [61] | Retrospective, single-center cohort study of patients with pre–renal transplant DSAs | Cohort | 2009–2013 | 48 | 2.20 (0.61–7.85) for rejection |
| Comoli et al. (2016) [20] | Retrospective analysis of consecutive pediatric recipients; single center; first kidney transplant without any HLA antibodies in sera or at the time of transplantation | Cohort | 2002–2013 | 114 | 6.91 (2.78–17.18) for rejection and C3d 13.54 (4.95–36.99) for rejection and C1q 27.80 (5.61–137.72) for graft loss and C3d 11.09 (2.25–54.64) for graft loss and C1q |
| Yamamoto et al. (2016) [62] | Retrospective analysis of renal transplant patients with de novo DSAs and surveillance biopsies | Cohort | 2009–2013 | 43 | 2.60 (0.12–53.90) for rejection |
| Calp–Inal et al. (2016) [18] | Retrospective analysis; single center; consecutive renal transplant patients: Group 1 without pretransplant DSAs and Group 2 with a mix of preexisting and de novo DSAs |
Cohort | 2009–2012 | 284 | 4.30 (1.10–16.50) for graft loss |
| Malheiro et al. (2016) [63] | Retrospective, single-center analysis of kidney transplant patients with DSAs pre transplant | Cohort | 2007–2012 | 60 | 16.80 (3.18–88.85) for rejection |
| Visentin et al. (2016) [64] | Retrospective, single-center analysis of lung transplant patients with biopsy (with demonstration of rejection) and serum available | Cohort | 1999–2014 | 53 | 1.65 (0.68–3.97) for graft loss |
| Kauke et al. (2016) [30] | Retrospective, single-center analysis of patients selected based on renal biopsy-proven rejection during graft dysfunction or viremia with polyomavirus BK | Cohort | 2005–2011 | 611 | 3.77 (1.40–10.16) for graft loss 4.52 (1.89–10.37) for rejection |
| Bamoulid et al. (2016) [65] | Retrospective, single-center analysis of renal transplant consecutive patients without DSAs pre transplant | Cohort | 2007–2014 | 59 | 2.27 (1.05–4.91) for rejection 6.78 (0.86–53.50) for graft loss |
| Fichtner et al. (2016) [21] | Retrospective, single-center analysis of prospectively screened renal transplant pediatric patients, non-presensitized | Cohort | 1999–2010 | 62 | 6.35 (1.33–30.40) for graft loss |
| Guidicelli et al. (2016) [19] | Retrospective, single-center analysis of consecutive nonsensitized kidney transplant patients | Cohort | 1998–2005 | 346 | 2.99 (0.94–10.27) for graft loss |
| Lefaucheur et al. (2016) [48] | Retrospective analysis of consecutive patients (2-center); renal transplant patients were unselected | Cohort | 2008–2010 | 125 | 4.80 (1.70–13.30) for IgG3 for graft loss 3.60 (1.10–11.70) for C1q for graft loss |
| Viglietti et al. (2017) [49] | Retrospective analysis of consecutive patients (2-center); renal transplant recipients were unselected | Cohort | 2008–2011 | 851 | 4.25 (1.88–9.61) for IgG3 for graft loss 3.60 (1.71–7.59) for C1q for graft loss |
| Wiebe et al. (2017) [27] | Retrospective analysis of consecutive adult and pediatric renal transplant patients, single center; patients without pretransplant sensitization | Cohort | 1999–2012 | 70 | 1.06 (0.50–2.40) for graft loss |
| Moktefi et al. (2017) [66] | Retrospective analysis (2-center) of patients selected based on the development of acute renal ABMR and the presence of DSAs | Cohort | 2005–2012 | 48 | 0.79 (0.25–2.44) for graft loss |
| Sicard et al. (2017) [67] | Retrospective analysis of consecutive adult renal transplant patients (2-center) with unselected patients | Cohort | 2004–2012 | 52 | 3.71 (1.27–10.80) for graft loss |
| Das et al. (2017) [68] | Retrospective, single-center analysis of pediatric heart transplant without DSAs pre transplantation and at the time of transplantation | Cohort | 2005–2014 | 127 | 3.20 (1.34–7.86) for graft loss |
| Couchonnal et al. (2017) [69] | Retrospective analysis; single-center analysis of consecutive pediatric liver transplant selected on the presence of DSAs during follow-up | Cohort | 1990–2014 | 100 | 4.12 (0.95–17.89) for graft loss |
| Bailly et al. (2017) [70] | Retrospective analysis of multicenter, prospective, randomized, double-blind, placebo-controlled, parallel-group trials; patients selected on the basis of renal ABMR development and DSA detection; patients treated either with standard of care (PP plus IVIg) or rituximab plus standard of care | Cohort | 2008–2011 | 25 | 3.70 (0.80–17.00) for graft loss |
| Molina et al. (2017) [71] | Retrospective analysis; single-center analysis of consecutive adult kidney transplant patients selected on pretransplant DSA detection | Cohort | 1995–2009 | 389 | 4.01 (2.33–6.92) for graft loss |
Effect sizes refer to HR for graft survival and OR for rejection appearance.
Abbreviations: ABMR, antibody-mediated rejection; C1q, complement component 1q; CI, confidence interval; DSA, donor-specific antibody; HLA, human leukocyte antigen; HR, hazard ratio; IgG3, immunoglobulin G3; IVIg: intravenous immunoglobulin; NC, not communicated; OR, odds ratio; PP, plasmapheresis.