Efficacy and safety of induction therapy in kidney transplantation: a network meta-analysis

초록

Introduction: Rejection and infection can occur after kidney transplantation are important factors in preserving graft kidney function. Therefore, the use of immunosuppressants in transplantation is important, and the question of what induction should be best used as an immunosuppressant is controversial. We have tried network meta-analysis of RCTs comparing induction therapy to find out which treatment is useful Method: To assess the comparative benefits and harms of different maintenance immunosuppressive induction in adults undergoing kidney transplantation through a network meta-analysis and to generate rankings of the different immunosuppressive regimens according to their safety and efficacy. We searched CENTRAL, MEDLINE, Embase, Science Citation Index Expanded, World Health Organization International Clinical Trials Registry Platform, and trials registers until May 2017 to identify randomized clinical trials on immunosuppression for kidney transplantation. Result: 27 studies involving 4,484 participants were eligible. Induction and maintenance treatments were administered for 12 months. There was no evidence of different effects between therapies on all-cause mortality, graft loss, CMV, BK virus, neutropenia, thrombocytopenia and AMR. However Compared to IV basiliximab, the most effective treatments to decrease biopsy proven acute rejection were IV Alemtuzumab and ATG (antithymocyte globulin) (ORs were 0.45 [95% CI, 0.29-40.78] and 0.63 [95% CI, 0.42-0.95] respectively). As a side effect, ATG had more bacterial infection than basiliximab (OR, 1.8; 95% CI, 1.01-2.8). Conclusion: The determination of induction in kidney transplantation is important for future prognosis of graft kidney. Alemtuzumab and ATG showed lower BPAR than Basiliximab. As a side effect, ATG produced more bacterial infection