Polyclonal and monoclonal antibodies for treating acute rejection episodes in kidney transplant recipients

Kidney transplantation is the treatment of choice for most patients with end‐stage renal disease (ESRD). Strategies to increase donor organ availability and to prolong the transplanted kidney's survival have become priorities in kidney transplantation. Fifteen to 35% of all kidney transplant recipients will experience one episode of acute rejection in the first year. Options for treating these episodes include pulsed steroid therapy, the use of an antibody preparation, the alteration of background immunosuppression, or combinations of these options. This review investigated the role of mono‐ or polyclonal antibodies (Ab) used to treat acute rejection in kidney transplant recipients. Twenty one trials (1387 patients) were included. Any antibody was better than steroid treatment for reversing the first acute rejection episode and preventing graft loss, but showed no significant difference in reversing steroid‐resistant rejection episodes. Antibody‐treated patients were 28 times more likely to experience an immediate reaction of fever, chills and malaise than those receiving steroid treatment. The main limitation of this review is that none of the included trials were performed using contemporary immunosuppressive regimens, with the most recent study performed in 2000.