实体器官移植诱导治疗的比较疗效与安全性：一项系统评价和网状Meta分析

Comparative efficacy and safety of induction therapy in solid organ transplantation: a systematic review and network meta-analysis.

作者信息

Sun Junjie, Hu Chao, Liang Qingwen, Yu Yanqing, Wen Ning, Dong Jianhui, Li Haibin, Sun Xuyong

机构信息

Institute of Transplantation Medicine, The Second Affiliated Hospital of Guangxi Medical University, Guangxi Clinical Research Center for Organ Transplantation, Guangxi Key Laboratory of Organ Donation and Transplantation, Nanning, Guangxi, China.

出版信息

Front Immunol. 2025 Jul 14;16:1625710. doi: 10.3389/fimmu.2025.1625710. eCollection 2025.

DOI:10.3389/fimmu.2025.1625710

PMID:40726985

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12301192/

Abstract

OBJECTIVE

To comparatively evaluate the efficacy and safety of induction therapies in solid organ transplantation (SOT) using a Bayesian network meta-analysis (NMA).

METHODS

Randomized controlled trials (RCTs) assessing induction therapies were systematically identified across major databases (up to November 20, 2024). The screening, data extraction, and risk of bias (ROB) assessment were independently conducted by two reviewers through standardized tools. Bayesian NMA synthesized outcomes, including rejection, graft/overall survival, and infection rates.

RESULTS

Sixty-eight RCTs (9,626 patients) evaluating 12 therapies were included. Surface Under the Cumulative Ranking Area (SUCRA) probabilities identified alemtuzumab as the most effective agent for reducing rejection rates (93.9%), followed by antilymphocyte globulin (ALG, 87.0%) and belimumab (77.0%). For graft survival, OKT3 ranked highest (87.9%), with subsequent superiority for ALG (83.5%) and alemtuzumab (75.6%). Basiliximab demonstrated the highest overall survival benefit (88.0%), outperforming rabbit antithymocyte globulin (rATG, 82.1%) and inolimomab (70.3%). Belimumab showed the greatest infection risk reduction (94.4%), surpassing alemtuzumab (80.0%) and basiliximab (74.5%).

CONCLUSION

Alemtuzumab emerged as the optimal therapy for minimizing rejection, while OKT3 and basiliximab were superior for graft and overall survival, respectively. Belimumab exhibited the strongest potential for reducing incidence of infection. These findings highlight therapy-specific advantages for optimizing SOT outcomes.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/PROSPERO/myprospero, identifier CRD42025634120.

摘要

目的

采用贝叶斯网络荟萃分析（NMA）比较评估实体器官移植（SOT）中诱导治疗的疗效和安全性。

方法

在各大数据库中系统检索评估诱导治疗的随机对照试验（RCT）（截至2024年11月20日）。由两名审阅者通过标准化工具独立进行筛选、数据提取和偏倚风险（ROB）评估。贝叶斯NMA综合了包括排斥反应、移植物/总生存率和感染率在内的结果。

结果

纳入了评估12种治疗方法的68项RCT（9626例患者）。累积排序曲线下面积（SUCRA）概率确定阿仑单抗是降低排斥率最有效的药物（93.9%），其次是抗淋巴细胞球蛋白（ALG，87.0%）和贝利木单抗（77.0%）。对于移植物存活，OKT3排名最高（87.9%），其次是ALG（83.5%）和阿仑单抗（75.6%）表现出优势。巴利昔单抗显示出最高的总生存获益（88.0%），优于兔抗胸腺细胞球蛋白（rATG，82.1%）和依诺利单抗（70.3%）。贝利木单抗显示出最大的感染风险降低（94.4%），超过阿仑单抗（80.0%）和巴利昔单抗（74.5%）。