*Purpose: The use of induction immunosuppressant agents in transplantation is important factors in preserving graft kidney function to prevent rejection. However the question of which induction therapy should be used as an immunosuppressant is controversial.

*Methods: The goal of this study was to assess the comparative benefits and harms of various maintenance immunosuppressive induction agents in adults undergoing kidney transplantation by using a network meta-analysis and to generate rankings of the different immunosuppressive regimens according to their safety and efficacy. MEDLINE, CENTRAL, Science Citation Index Expanded, EMBASE, World Health Organization International Clinical Trials Registry Platform, and trial registers were searched until June 2020 to identify randomized controlled trials on immunosuppression during kidney transplantation.

*Results: Thirty-two studies involving 5239 participants were eligible for analysis. Induction and maintenance treatments were administered for 12 months. There was no evidence of differences in outcomes between therapies on all-cause mortality, graft loss, antibody mediated rejection, BK virus, cytomegalovirus and thrombocytopenia. However, compared with intravenous basiliximab (an interleukin-2 receptor antagonist [IL-2RA]), the most effective treatments to decrease biopsy-proven acute rejection were rabbit antithymocyte globulin (rATG). The odds ratios were 0.53 (95% confidence interval [CI], 0.29-0.86). However, as a side effect, rATG was accompanied by more bacterial infection than the IL-2RA (OR, 1.91 [95% CI, 1.21-2.42]).

*Conclusions: The determination of induction in kidney transplantation is important for future prognosis of the graft kidney. rATG exhibited lower biopsy-proven acute rejection than the IL-2RA. As a side effect, rATG produced frequent bacterial infections.

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