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Abstract Background and Objectives Heart and lung transplantation is a high-risk procedure requiring intensive immunosuppressive therapy for preventing organ rejection. Alemtuzumab, a CD52-specific monoclonal antibody, is increasingly used for induction therapy compared with conventional agents. However, there has been no systematic review comparing its efficacy with traditional therapeutic drugs. Methods PubMed and EMBASE were searched to October 1, 2017, for articles on alemtuzumab in cardiothoracic transplant surgery. Of the 433 studies retrieved, 8 were included in the final meta-analysis. Results In lung transplantation, alemtuzumab use was associated with lower odds of acute cellular rejection compared with antithymocyte globulin (odds ratio [OR], 0.21; 95% CI, 0.11–0.40; P <.001), lower acute rejection rates (OR, 0.12; 95% CI, 0.03–0.55; P <.01), and infection rates (OR, 0.69; 95% CI, 0.35–1.36; P =.33) when compared with basiliximab. Multivariate meta-regression analysis found that mean age, male sex, single lung transplant, double lung transplant, cytomegalovirus or Epstein-Barr virus status, idiopathic pulmonary fibrosis, cystic fibrosis, and mean ischemic time did not significantly influence acute rejection outcomes. For heart transplantation, alemtuzumab use was associated with lower acute rejection rates when compared with tacrolimus (OR, 0.44; 95% CI, 0.30–0.66; P <.001). Conclusions Alemtuzumab use was associated with lower rejection rates when compared with conventional induction therapy agents (antithymocyte globulin, basiliximab, and tacrolimus) in heart and lung transplantation. However, this was based on observational studies. Randomized controlled trials are needed to verify its clinical use. Highlights • More randomized controlled trials should be conducted to explore the clinical use of alemtuzumab. • There is a potential trend toward lower acute cellular rejection rate with alemtuzumab. • There is a potential trend toward lower infection rate with alemtuzumab. [ABSTRACT FROM AUTHOR]

Abstract Background and objectives Heart and lung transplantation is a high-risk procedure, requiring intensive immunosuppressive therapy for preventing organ rejection. Alemtuzumab, a CD52-specific monoclonal antibody, is increasingly used for induction therapy compared with conventional agents. However, there has been no systematic review comparing its efficacy with traditional therapeutic drugs. Methods PubMed and EMBASE were searched to October 1, 2017, for articles on alemtuzumab in cardiothoracic transplant surgery. Of the 433 studies retrieved, 8 were included in the final meta-analysis. Results In lung transplantation, alemtuzumab use was associated with lower odds of acute cellular rejection compared with antithymocyte globulin (odds ratio [OR], 0.21; 95% CI, 0.11–0.40; P <.001), lower acute rejection rates (OR, 0.12; 95% CI, 0.03–0.55; P <.01), and lower infection rates (OR, 0.69; 95% CI, 0.35–1.36; P =.33) when compared with basiliximab. Multivariate meta-regression analysis found that mean age, male sex, single lung transplant, double lung transplant, cytomegalovirus or Epstein-Barr virus status, idiopathic pulmonary fibrosis, cystic fibrosis, and mean ischemic time did not significantly influence acute rejection outcomes. For heart transplantation, alemtuzumab use was associated with lower acute rejection rates when compared with tacrolimus (OR, 0.44; 95% CI, 0.30–0.66; P <.001). Conclusions Alemtuzumab use was associated with lower rejection rates when compared with conventional induction therapy agents (antithymocyte globulin, basiliximab, and tacrolimus) in heart and lung transplantation. However, this was based on observational studies. Randomized controlled trials are needed to verify its clinical use. Highlights • More randomized controlled trials should be conducted to explore the clinical use of alemtuzumab. • Potential trend toward lower acute cellular rejection rate with alemtuzumab. • Potential trend toward lower infection rate with alemtuzumab. [ABSTRACT FROM AUTHOR]