Montero Nuria, Rodrigo Emilio, Crespo Marta, Cruzado Josep M, Gutierrez-Dalmau Alex, Mazuecos Auxiliadora, Sancho Asunción, Belmar Lara, Calatayud Emma, Mora Paula, Oliveras Laia, Solà Eulalia, Villanego Florentino, Pascual Julio
Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
Nephrology Department, Hospital Universitario Marqués de Valdecilla/IDIVAL, Santander, Spain.
Transplant Rev (Orlando). 2023 Dec;37(4):100795. doi: 10.1016/j.trre.2023.100795. Epub 2023 Sep 21.
Recommendations of the use of antibody induction treatments in kidney transplant recipients (KTR) are based on moderate quality and historical studies. This systematic review aims to reevaluate, based on actual studies, the effects of different antibody preparations when used in specific KTR subgroups.
We searched MEDLINE and CENTRAL and selected randomized controlled trials (RCT) and observational studies looking at different antibody preparations used as induction in KTR. Comparisons were categorized into different KTR subgroups: standard, high risk of rejection, high risk of delayed graft function (DGF), living donor, and elderly KTR. Two authors independently assessed the risk of bias.
Thirty-seven RCT and 99 observational studies were finally included. Compared to anti-interleukin-2-receptor antibodies (IL2RA), anti-thymocyte globulin (ATG) reduced the risk of acute rejection at two years in standard KTR (RR 0.74, 95%CI 0.61-0.89) and high risk of rejection KTR (RR 0.55, 95%CI 0.43-0.72), but without decreasing the risk of graft loss. We did not find significant differences comparing ATG vs. alemtuzumab or different ATG dosages in any KTR group.
Despite many studies carried out on induction treatment in KTR, their heterogeneity and short follow-up preclude definitive conclusions to determine the optimal induction therapy. Compared with IL2RA, ATG reduced rejection in standard-risk, highly sensitized, and living donor graft recipients, but not in high DGF risk or elderly recipients. More studies are needed to demonstrate beneficial effects in other KTR subgroups and overall patient and graft survival.
关于肾移植受者（KTR）使用抗体诱导治疗的建议基于质量中等的历史研究。本系统评价旨在根据实际研究重新评估不同抗体制剂在特定KTR亚组中的应用效果。
我们检索了MEDLINE和CENTRAL，并选择了观察不同抗体制剂用于KTR诱导治疗的随机对照试验（RCT）和观察性研究。比较分为不同的KTR亚组：标准组、高排斥风险组、移植肾功能延迟恢复（DGF）高风险组、活体供肾组和老年KTR组。两位作者独立评估偏倚风险。
最终纳入37项RCT和99项观察性研究。与抗白细胞介素-2受体抗体（IL2RA）相比，抗胸腺细胞球蛋白（ATG）降低了标准KTR组（RR 0.74，95%CI 0.61-0.89）和高排斥风险KTR组（RR 0.55，95%CI 0.43-0.72）两年时急性排斥反应的风险，但未降低移植肾丢失风险。在任何KTR组中，我们未发现ATG与阿仑单抗或不同ATG剂量之间的显著差异。
尽管对KTR的诱导治疗进行了许多研究，但其异质性和随访时间短妨碍了确定最佳诱导治疗的明确结论。与IL2RA相比，ATG降低了标准风险、高敏和活体供肾移植受者的排斥反应，但在DGF高风险或老年受者中未降低。需要更多研究来证明在其他KTR亚组以及患者和移植肾总体生存方面的有益效果。
