Objectives To compare the efficacy and safety of antithymocyte globulin (ATG) and interleukin 2 receptor antagonist (IL2Ra) in induction therapy of kidney transplantation.

Method A literature search was performed in Aug 2017. The primary sources were the randomized controlled trials from electronic database of PubMed, EMBASE and CENTRAL. Patient survival, graft loss and death, death censored graft loss, delay graft function (DGF), biopsy-proven acute rejection (BPAR), steroid-resistant rejection, all-cause infection, CMV infection, malignancy, post-transplant lymphoproliferative disease (PTLD), post-transplant diabetes mellitus (PTDM), leucopenia and thrombocytopenia were brought into analyses. Risk ratios with 95% confidence interval were reported as results.

Result We included 12 trails and analyzed the 1-year post-transplant outcomes. The meta-analysis showed the risk of biopsy proven acute rejection (BPAR) and steroid-resistant rejection were reduced by 24% and 62% in patients receiving ATG respectively. (BPAR: RR 0.76, 95%CI 0.61-0.95, I²=0; Steroid-resistant rejection: RR 0.38, 95%CI 0.20-0.71, I²=7%). Patients receiving ATG showed 286% increment in malignancy (6 trials, RR 3.86, 95%CI 1.38-10.81, I²=0%). All-cause infection and CMV infection were increased by 9% and 28% in patient receiving ATG respectively (All-cause infection: RR 1.09, 95%CI 1.00-1.19, I²=8%; CMV infection: RR 1.28, 95%CI 1.06-1.55, I²=62%). More adverse reaction occurred in ATG treated recipients, the incidence of leucopenia and thrombocytopenia were increase 149% and 191% respectively (leucopenia: RR 2.49, 95%CI 1.78-3.49, I²=0%; thrombocytopenia: RR 2.91, 95%CI 1.96-4.33, I²=40%).The pooled analyses showed no significant differences in 1-year patient survival, Graft loss or death with a functioning allograft, Graft loss censored for death, delay graft function, PTLD and PTDM. Sensitivity analysis was performed and showed more homogeneous result of CMV infection (RR 1.50, 95%CI 1.14-1.97, I²=35%).

Conclusions Compared with IL2Ra, patients receiving ATG had lower risk of rejection but suffered more infection, malignancy and adverse reaction.

CITATION INFORMATION: Chen G., Wu Z., Wang C., Liu X., Wang C., Chen L. A Meta-Analysis for Induction Therapy of Kidney Transplantation: Comparison of Antithymocyte Globulin and Interleukin 2 Receptor Antagonist Am J Transplant. 2017;17 (suppl 3).

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