-
PloS One 2020Existing systematic reviews of Rh immunoprophylaxis include only data from randomized controlled trials, have dated searches, and some do not report on all domains of...
BACKGROUND
Existing systematic reviews of Rh immunoprophylaxis include only data from randomized controlled trials, have dated searches, and some do not report on all domains of risk of bias or evaluate the certainty of the evidence. Our objective was to perform an updated review, by including new trials, any comparative observational studies, and assessing the certainty of the evidence using the GRADE framework.
METHODS
We searched MEDLINE, Embase and the Cochrane Library from 2000 to November 26, 2019. Relevant websites and bibliographies of systematic reviews and guidelines were searched for studies published before 2000. Outcomes of interest were sensitization and adverse events. Risk of bias was evaluated with the Cochrane tool and ROBINS-I. The certainty of the evidence was performed using the GRADE framework.
RESULTS
Thirteen randomized trials and eight comparative cohort studies were identified, evaluating 12 comparisons. Although there is some evidence of beneficial treatment effects (e.g., at 6-months postpartum, fewer women who received RhIg at delivery compared to no RhIg became sensitized [70 fewer sensitized women per 1,000 (95%CI: 67 to 71 fewer); I2 = 73%]), due to very low certainty of the evidence, the magnitude of the treatment effect may be overestimated. The certainty of the evidence was very low for most outcomes often due to high risk of bias (e.g., randomization method, allocation concealment, selective reporting) and imprecision (i.e., few events and small sample sizes). There is limited evidence on prophylaxis for invasive fetal procedures (e.g. amniocentesis) in the comparative literature, and few studies reported adverse events.
CONCLUSION
Serious risk of bias and low to very low certainty of the evidence is found in existing RCTs and comparative observational studies addressing optimal effectiveness of Rh immunoprophylaxis. Guideline development committees should exercise caution when assessing the strength of the recommendations that inform and influence clinical practice in this area.
Topics: Female; GRADE Approach; Humans; Immunologic Factors; Postnatal Care; Pregnancy; Prenatal Care; Randomized Controlled Trials as Topic; Rh Isoimmunization; Rh-Hr Blood-Group System
PubMed: 32913362
DOI: 10.1371/journal.pone.0238844 -
Transplantation Proceedings Dec 2020ABO-incompatible living kidney transplantation (ABOILKT) has steadily become more widespread. However, the optimal immunosuppressive regimen for ABOILKT remains... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
ABO-incompatible living kidney transplantation (ABOILKT) has steadily become more widespread. However, the optimal immunosuppressive regimen for ABOILKT remains uncertain. We aimed to determine the outcomes according to dose of rituximab induction.
METHODS
We conducted a systematic review and meta-analysis using random-effects modeling. We searched the following databases for all studies published through May 15, 2019: Cochrane Central Register, OVID MEDLINE, EMBASE, and PubMed. We reviewed all relevant reviews, registered trials, and relevant conference proceedings to compare clinical outcomes and survival according to dose of rituximab as induction in kidney transplantation.
RESULTS
Five trials with a total of 390 patients were included. Glomerular filtration rates, graft loss, antibody mediated rejection, T cell mediated rejection, fungal infection (Candida), and patient survival rates did not differ between the 200 mg single dose and 375 mg/m in rituximab groups. However, incidence rate of infection 0.470 (95% confidence interval [CI], 0.264 to 0.838) had a lower result than the 200 mg rituximab group.
CONCLUSIONS
The using of a 200 mg single dose of rituximab induction in ABOILKT has not only the same results for rejection, graft survival, and patient survival but also low incidence of infection after transplantation.
Topics: ABO Blood-Group System; Antibodies; Blood Group Incompatibility; Dose-Response Relationship, Drug; Graft Rejection; Graft Survival; Humans; Immunosuppressive Agents; Kidney Transplantation; Rituximab
PubMed: 32553506
DOI: 10.1016/j.transproceed.2020.02.166 -
World Journal of Pediatrics : WJP Oct 2020Jaundice is a life-threatening disorder in the neonates. In the present study, we aimed to assess systematically available evidence on causes and management of jaundice... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Jaundice is a life-threatening disorder in the neonates. In the present study, we aimed to assess systematically available evidence on causes and management of jaundice in Iranian newborn patients.
METHODS
We searched the databases of PubMed, Web of Sciences, Scopus and Google Scholar for English articles published since inception until May 2019. A search was also done for Persian articles in Magiran and Scientific Information Database. Studies were evaluated based on predefined criteria by two reviewers. Data analysis was performed by STATA software.
RESULTS
A total of 33 articles were finally included. The overall pooled prevalence of causes of jaundice among Iranian neonates was as follows: ABO blood groups incompatibility, 16.9% [95% confidence interval (CI) 10.9-22.8]; Rh blood group incompatibility, 4% (95% CI 2.5-5.5); ABO and Rh blood groups incompatibility, 3.6% (95% CI 0-7.7); glucose-6-phosphate dehydrogenase (G6PD) deficiency, 6.3% (95% CI 5.1-7.5); infection, 6.6% (95% CI 5.2-8.1); hypothyroidism, 4.2% (95% CI 0.1-8.3); infant of diabetic mother: 2.3% (95% CI 0.1-4.5); unknown, 50.7% (95% CI 33.4-68); cephalohematoma, 0.6% (95% CI 0.3-0.9). Regarding treatment of icterus, seven and eight articles were found on phototherapy and exchange transfusion, respectively. In five studies, all patients underwent phototherapy, but rate of exchange transfusion use was between 6.6% and 50.9%.
CONCLUSIONS
According to the results, unknown factors were the most common causes of icterus in Iranian neonates, followed by ABO blood groups incompatibility, infections and G6PD deficiency. By the way, phototherapy and exchange transfusion were found as therapeutic choices of neonatal jaundice.
Topics: Humans; Infant, Newborn; Iran; Jaundice, Neonatal
PubMed: 32052364
DOI: 10.1007/s12519-020-00339-3 -
BMC Pregnancy and Childbirth Feb 2020All non-sensitized Rhesus D (RhD)-negative pregnant women in Germany receive antenatal anti-D prophylaxis without knowledge of fetal RhD status. Non-invasive prenatal...
BACKGROUND
All non-sensitized Rhesus D (RhD)-negative pregnant women in Germany receive antenatal anti-D prophylaxis without knowledge of fetal RhD status. Non-invasive prenatal testing (NIPT) of cell-free fetal DNA in maternal plasma could avoid unnecessary anti-D administration. In this paper, we systematically reviewed the evidence on the benefit of NIPT for fetal RhD status in RhD-negative pregnant women.
METHODS
We systematically searched several bibliographic databases, trial registries, and other sources (up to October 2019) for controlled intervention studies investigating NIPT for fetal RhD versus conventional anti-D prophylaxis. The focus was on the impact on fetal and maternal morbidity. We primarily considered direct evidence (from randomized controlled trials) or if unavailable, linked evidence (from diagnostic accuracy studies and from controlled intervention studies investigating the administration or withholding of anti-D prophylaxis). The results of diagnostic accuracy studies were pooled in bivariate meta-analyses.
RESULTS
Neither direct evidence nor sufficient data for linked evidence were identified. Meta-analysis of data from about 60,000 participants showed high sensitivity (99.9%; 95% CI [99.5%; 100%] and specificity (99.2%; 95% CI [98.5%; 99.5%]).
CONCLUSIONS
NIPT for fetal RhD status is equivalent to conventional serologic testing using the newborn's blood. Studies investigating patient-relevant outcomes are still lacking.
Topics: Chemoprevention; Female; Fetal Blood; Humans; Infant, Newborn; Medical Overuse; Noninvasive Prenatal Testing; Pregnancy; Pregnancy Complications, Hematologic; Prenatal Care; Rh Isoimmunization; Rh-Hr Blood-Group System; Rho(D) Immune Globulin
PubMed: 32033599
DOI: 10.1186/s12884-020-2742-4 -
Transplantation Proceedings 2019Human leukocyte antigen match is the most important donor factor affecting transplant outcome. The HLA-DPB1 mismatch on the clinical outcome of hematopoietic stem cell... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Human leukocyte antigen match is the most important donor factor affecting transplant outcome. The HLA-DPB1 mismatch on the clinical outcome of hematopoietic stem cell transplant (HSCT) is less clear. This study is the first meta-analysis to investigate the impact of HLA-DPB1 loci mismatch on clinical outcome after unrelated donor HSCT for hematologic malignant disease.
METHODS
We electronically searched the PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and a related database (January 1995-December 2018) for all relevant articles. Comparative studies were carried out to investigate the impact of HLA-DPB1 loci mismatch on clinical outcome after unrelated donor HSCT, that is, the disease-free survival, engraftment, graft-vs-host disease, relapse, and transplant-related mortality (TRM). We performed a meta-analysis using Review Manager 5.3.5 software and adopted funnel plot regression to assess the publication bias.
RESULTS
A total of 1570 articles were retrieved; 21 studies including 27,852 patients were assessed. Pooled comparisons of studies found that the HLA-DPB1-mismatched group had a lower rate of disease-free survival than the DPB1-matched group and lower overall survival in non-T cell-depleted transplant than the DPB1-matched group. The DPB1-mismatched group has higher incidence of acute graft-vs-host disease (aGVHD) and severe (≥ III degree) aGVHD, lower relapse rate, and higher TRM. Moreover, compared with 1-antigen mismatch, 2-antigen mismatch in DPB1 had a higher risk of TRM and a lower relapse rate, and the nonpermissive DPB1 mismatch had significantly higher rate of severe aGvHD and lower rate of disease relapse.
CONCLUSIONS
This analysis confirmed that HLA-DPB1 has important influence on survival and transplant-related complications during unrelated donor HSCT, and HLA-DPB1 donor selection strategies have been proposed based on personalized algorithm.
Topics: Adult; Blood Group Incompatibility; Child, Preschool; Disease-Free Survival; Female; Graft vs Host Disease; HLA-DP beta-Chains; Hematologic Neoplasms; Hematopoietic Stem Cell Transplantation; Histocompatibility Testing; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Randomized Controlled Trials as Topic; Treatment Outcome; Unrelated Donors
PubMed: 31399180
DOI: 10.1016/j.transproceed.2019.04.053 -
Transfusion Medicine Reviews Jul 2019Sickle cell disease (SCD) is the most common monogenic disorder in sub-Saharan Africa (SSA). Blood transfusion to increase the oxygen carrying capacity of blood is vital... (Meta-Analysis)
Meta-Analysis
Sickle cell disease (SCD) is the most common monogenic disorder in sub-Saharan Africa (SSA). Blood transfusion to increase the oxygen carrying capacity of blood is vital in the management of many patients with SCD. However, red blood cell (RBC) alloimmunization is a major challenge to transfusions in these patients. Commonly in SSA, pretransfusion tests only involve ABO D grouping and compatibility without RBC antibody testing. Data on the frequency of RBC alloimmunization in patients with SCD in SSA are limited. We performed a systematic review and meta-analysis on available data on alloimmunization in transfused patients with SCD to determine the published prevalence of RBC alloimmunization in SCD patients in SSA. Six databases were systematically searched to identify relevant studies, without year or language restrictions. In all, 249 articles were identified and 15 met our selection criteria. The overall proportion of alloimmunization was 7.4 (95% confidence interval: 5.1-10.0) per 100 transfused patients. Antibodies against E, D, C, and K antigens accounted for almost half of antibody specificities, and antibodies to low- and high-frequency antigens were also common and represented almost 30% (20% to low-frequency antigens and 9% to high-frequency antigens) of specificities. Heterogeneity between studies was moderate, and meta-analysis found region of Africa as the major contributor to the heterogeneity. We also observed inconsistencies across studies in reporting of factors that may influence alloimmunization. This review provides an overview of the extent of the alloimmunization problem in SSA and provides a baseline against which to compare the effect of any interventions to reduce the alloimmunization risk.
Topics: Africa South of the Sahara; Anemia, Sickle Cell; Blood Group Incompatibility; Erythrocyte Transfusion; Erythrocytes; Humans; Prevalence; Regression Analysis; Transfusion Reaction
PubMed: 31345590
DOI: 10.1016/j.tmrv.2019.06.003 -
Journal of Perinatology : Official... Jul 2019To estimate the prevalence and characteristics of fetal thrombocytopenia at the time of percutaneous umbilical cord sampling (PUBS) in pregnancies complicated by... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To estimate the prevalence and characteristics of fetal thrombocytopenia at the time of percutaneous umbilical cord sampling (PUBS) in pregnancies complicated by alloimmunization and to conduct a systematic review on fetal thrombocytopenia in these pregnancies.
STUDY DESIGN
Retrospective cohort study of all patients undergoing PUBS at our institution from 2000-2017. Clinical data, including fetal platelet counts, were abstracted from the medical record and analyzed with routine statistical procedures. A systematic review and meta-analysis were also conducted according to standard procedures.
RESULT
At first procedure, prior to any transfusion, 13/36 fetuses (36%) had thrombocytopenia: 11/36 (31%) had moderate thrombocytopenia and 2/36 (6%) had severe thrombocytopenia (14 patients had no platelet count at first procedure). The systematic review identified six studies, and the prevalence of fetal thrombocytopenia at the time of PUBS for alloimmunization was 18% (95% confidence interval 11%, 26%).
CONCLUSION
Thrombocytopenia is common and underappreciated in fetuses undergoing PUBS for alloimmunization.
Topics: Anemia; Antigens, Human Platelet; Blood Group Incompatibility; Female; Fetal Blood; Fetal Diseases; Fetoscopy; Gestational Age; Humans; Platelet Count; Pregnancy; Pregnancy Complications, Hematologic; Retrospective Studies; Thrombocytopenia
PubMed: 31073147
DOI: 10.1038/s41372-019-0388-8 -
Lancet (London, England) May 2019ABO-incompatible renal transplantation (ABOi-rTx) is increasingly used to overcome organ shortage. Evidence about its non-inferiority in comparison with ABO-compatible... (Meta-Analysis)
Meta-Analysis
BACKGROUND
ABO-incompatible renal transplantation (ABOi-rTx) is increasingly used to overcome organ shortage. Evidence about its non-inferiority in comparison with ABO-compatible renal transplantation (ABOc-rTx) needs to be analysed at early and late timepoints. We aimed to investigate differences in outcome after ABOi-rTX and ABOc-rTX.
METHODS
We did a systematic review and meta-analysis of observational studies published up until Dec 31, 2017, that reported outcome data (≥1 year of follow-up) after ABOi-rTx and included an ABO-compatible control group, by searching the Cochrane Central Register of Controlled Trials (CENTRAL), Embase Ovid, MEDLINE Ovid, and PubMed. Trials on recipients of ABOi-rTx were assessed, if an ABO-compatible control group was included and if outcome data on at least graft or recipient survival with 1 year or more of follow-up were available. Exclusion criteria included case reports, editorials, reviews and letters, animal studies, meeting papers, studies unable to extract data, non-renal solid organ and bone-marrow transplant studies, and deceased donor ABOc-rTx. Data were extracted from published reports. Primary endpoints were all-cause mortality and graft survival at 1, 3, 5, and more than 8 years after transplantation. In the meta-analysis, we used a fixed-effects model if the I value was 0, and both a fixed-effects and random-effects model if I was more than 0. This study is registered with PROSPERO, number CRD42018094550.
FINDINGS
1264 studies were screened and 40 studies including 49 patient groups were identified. 65 063 patients were eligible for analysis, 7098 of whom had undergone ABOi-rTx. Compared with ABOc-rTx, ABOi-rTx was associated with significantly higher 1-year mortality (odds ratio [OR] 2·17 [95% CI 1·63-2·90], p<0·0001; I=37%), 3 years (OR 1·89 [1·46-2·45], p<0·0001; I=29%), and 5 years (OR 1·47 [1·08-2·00], p=0·010; I=68%) following transplantation. Death-censored graft survival was lower with ABOi-rTx than with ABOc-rTx at 1 year (OR 2·52 [1·80-3·54], p<0·0001; I=61%) and 3 years (OR 1·59 [1·15-2·18], p=0·0040; I=58%) only. Graft losses were equivalent to that of ABOc-rTx after 5 years and patient survival after 8 years. No publication bias was detected and the results were robust to trial sequential analysis until 5 years after transplantation; thereafter, data became futile or inconclusive.
INTERPRETATION
Despite progress in desensitisation protocols and optimisation of ABOi-rTx procedures, excess mortality and loss of kidney grafts was found compared with ABOc-rTx within the first 3 years after transplantation. Only long-term outcomes after 5 years yielded equivalent survival rates and organ function. Awareness of the increased risks of infection, organ rejection, and bleeding could improve care of patients and promote efforts towards paired kidney exchange programmes.
FUNDING
None.
Topics: Blood Group Incompatibility; Female; Graft Rejection; Graft Survival; Humans; Kidney Transplantation; Living Donors; Male; Observational Studies as Topic; Odds Ratio; Outcome Assessment, Health Care
PubMed: 31006573
DOI: 10.1016/S0140-6736(18)32091-9 -
Blood Transfusion = Trasfusione Del... Jan 2019Chronic red blood cell transfusion is the first-line treatment for severe forms of thalassaemia. This therapy is, however, hampered by a number of adverse effects,...
BACKGROUND
Chronic red blood cell transfusion is the first-line treatment for severe forms of thalassaemia. This therapy is, however, hampered by a number of adverse effects, including red blood cell alloimmunisation. The aim of this systematic review was to collect the current literature data on erythrocyte alloimmunisation.
MATERIALS AND METHODS
We performed a systematic search of the literature which identified 41 cohort studies involving 9,256 patients.
RESULTS
The prevalence of erythrocyte alloimmunisation was 11.4% (95% CI: 9.3-13.9%) with a higher rate of alloimmunisation against antigens of the Rh (52.4%) and Kell (25.6%) systems. Overall, alloantibodies against antigens belonging to the Rh and Kell systems accounted for 78% of the cases. A higher prevalence of red blood cell alloimmunisation was found in patients with thalassaemia intermedia compared to that among patients with thalassaemia major (15.5 vs 12.8%).
DISCUSSION
Matching transfusion-dependent thalassaemia patients and red blood cell units for Rh and Kell antigens should be able to reduce the risk of red blood cell alloimmunisation by about 80%.
Topics: Erythrocyte Transfusion; Erythrocytes; Humans; Prevalence; Rh Isoimmunization; Rh-Hr Blood-Group System; Thalassemia; Transfusion Reaction
PubMed: 30653458
DOI: 10.2450/2019.0229-18 -
Transfusion Medicine Reviews Jan 2019Red blood cells (RBC) transfusion is critical in managing acute and chronic complications in sickle cell disease (SCD); however, it is complicated by RBC...
Red blood cells (RBC) transfusion is critical in managing acute and chronic complications in sickle cell disease (SCD); however, it is complicated by RBC alloimmunization, iron overload, transfusion reactions and infection. Several reports documented an increased incidence of alloantibodies in transfused individuals with SCD, especially for Rh and Kell antigens. As a result, the National Institutes of Health Expert Panel and British Society for Haematology guidelines recommend primary matching for C/c, E/e and K antigens in addition to ABO/RhD for RBC transfusions. However, the evidence supporting these recommendations was cited as limited and understanding of alloimmunization in SCD is evolving. To examine the limitations of the evidence, we undertook a systematic review of evidence behind recommendations for limited and extended serologic and genotypic RBC antigen matching to reduce alloimmunization, autoimmunization and transfusion reactions. Searches of PubMed, Embase, Cochrane, and Web of Science databases using MeSH index and free text terms between 1976 through October 2015 and papers and captured through July 2016 through review references in papers, word of mouth, and ongoing Google Scholar and Medline Alerts identified 303 unique articles. Nineteen articles met inclusion criteria and were classified by the Oxford Centre Evidence Based levels of evidence. Strengthening the Reporting of Observational Studies in Epidemiology checklists were completed for 18 of the 19 studies. There were no prospective randomized controlled trials. Sixteen of the articles were cohort studies, two were cross-sectional studies, and one decision tree model examining costs. Low-quality evidence from observational cohort studies supports that alloimmunization prevalence can be decreased by extending serological RBC antigen matching. Transfusion reactions are generally poorly and inconsistently reported. There was no evidence reporting the effect prophylactic genotypic matching has on alloimmunization, autoimmunization or transfusion reactions. There were no studies comparing prophylactic genotypic matching to serologic matching. High-quality evidence was lacking to support clinical decision making regarding best transfusion practices. Multicenter prospective randomized clinical trials are needed to determine best strategies for reducing the rate of alloimmunization using serologic and genotypic matching.
Topics: ABO Blood-Group System; Anemia, Sickle Cell; Blood Group Incompatibility; Blood Grouping and Crossmatching; Blood Transfusion; Cross-Sectional Studies; Erythrocyte Transfusion; Erythrocytes; Genotype; Humans; Isoantibodies; Observational Studies as Topic; Prospective Studies; Rh-Hr Blood-Group System; Transfusion Reaction
PubMed: 30122266
DOI: 10.1016/j.tmrv.2018.07.003