Department of Urology, Organ Transplantation Center, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.
West China Medical School, Sichuan University, Chengdu, China.
Front Immunol. 2020 Apr 3;11:457. doi: 10.3389/fimmu.2020.00457. eCollection 2020.
Thymoglobulin (THG) and antithymocyte globulin-Fresenius (ATG-F) have not been compared directly as induction therapies in kidney transplantation. We performed a Bayesian network meta-analysis to compare THG with ATG-F by pooling direct and indirect evidence. Surface under the cumulative ranking curve (SUCRA) values were used to compare the superiority of one method over the other. A total of 27 randomized controlled trials (RCT) were eligible for the network meta-analysis. Efficacy endpoints, as well as safety indicators, were statistically comparable. For efficacy endpoints, THG seemed inferior to ATG-F in preventing delayed graft function [odds ratio (OR): 1.27; SUCRA: 78% vs. 58%], patient deaths (OR: 2.78; SUCRA: 83% vs. 34%), and graft loss (OR: 1.40; SUCRA: 83% vs. 59%), but superior to ATG-F in biopsy-proven acute rejection (BPAR; OR: 0.59; SUCRA: 78% vs. 39%) and steroid-resistant BPAR prevention (OR: 0.61; SUCRA: 76% vs. 49%) within the first year. For safety endpoints, THG was associated with higher risk of infection (OR: 1.49, SUCRA: 79% vs. 54%), cytomegalovirus infection (OR: 1.04; SUCRA: 40% vs. 37%), diabetes (OR: 1.10; SUCRA: 90% vs. 30%), and malignancy (OR: 8.40; SUCRA: 89% vs. 6%) compared to ATG-F. A subgroup analysis of patients at high risk for immunologic complications revealed similar results, but THG performed better for graft loss (OR: 0.82; SUCRA: 68% vs. 54%). ATG-F seemed to be more effective than THG in improving the short-term kidney transplantation outcomes. Prospective head-to-head comparison of THG and ATG-F with larger sample sizes and longer follow-up is still required.
胸腺球蛋白（THG）和抗胸腺细胞球蛋白-Fresenius（ATG-F）尚未在肾移植中作为诱导治疗进行直接比较。我们通过合并直接和间接证据进行了贝叶斯网络荟萃分析，以比较 THG 与 ATG-F。累积排序曲线下面积（SUCRA）值用于比较一种方法相对于另一种方法的优越性。共有 27 项随机对照试验（RCT）符合网络荟萃分析的纳入标准。疗效终点和安全性指标在统计学上具有可比性。对于疗效终点，THG 在预防延迟移植物功能障碍方面似乎不如 ATG-F [比值比（OR）：1.27；SUCRA：78%比 58%]、患者死亡（OR：2.78；SUCRA：83%比 34%）和移植物丢失（OR：1.40；SUCRA：83%比 59%），但在活检证实的急性排斥反应（BPAR；OR：0.59；SUCRA：78%比 39%）和预防类固醇耐药性 BPAR 方面优于 ATG-F [OR：0.61；SUCRA：76%比 49%]在第一年。对于安全性终点，THG 与更高的感染风险相关（OR：1.49，SUCRA：79%比 54%）、巨细胞病毒感染（OR：1.04；SUCRA：40%比 37%）、糖尿病（OR：1.10；SUCRA：90%比 30%）和恶性肿瘤（OR：8.40；SUCRA：89%比 6%）与 ATG-F 相比。在高免疫并发症风险的患者亚组分析中得到了相似的结果，但 THG 在移植物丢失方面表现更好（OR：0.82；SUCRA：68%比 54%）。ATG-F 在改善短期肾移植结局方面似乎比 THG 更有效。仍需要前瞻性头对头比较 THG 和 ATG-F，样本量更大，随访时间更长。
