Abstract：
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
背景：关于在肾移植受者（KTR）中使用抗体诱导治疗的建议是基于中等质量和历史研究。这篇系统的综述旨在重新评估，根据实际研究，不同抗体制剂用于特定KTR亚组时的效果。
方法：我们搜索了MEDLINE和CENTRAL，并选择了随机对照试验（RCT）和观察性研究，研究了不同的抗体制剂在KTR中的诱导作用。比较分为不同的KTR亚组：标准，拒绝的风险很高，移植物功能延迟（DGF）的高风险，活体捐赠者,老年KTR两位作者独立评估了偏倚的风险。
结果：最终纳入了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)可降低标准KTR患者2年急性排斥反应的风险(RR0.74,95CI0.61-0.89)和高排斥反应风险(RR0.55,95CI0.43-0.72),但不会降低移植物丢失的风险。我们没有发现显着差异比较ATG与阿仑单抗或任何KTR组的不同ATG剂量。
结论：尽管进行了许多关于KTR诱导治疗的研究，它们的异质性和短期随访排除了确定最佳诱导治疗的明确结论.与IL2RA相比，ATG降低了标准风险中的拒绝，高度敏感，和活体移植接受者，但不是在高DGF风险或老年接受者。需要更多的研究来证明在其他KTR亚组以及总体患者和移植物存活中的有益效果。
方法：我们搜索了MEDLINE和CENTRAL，并选择了随机对照试验（RCT）和观察性研究，研究了不同的抗体制剂在KTR中的诱导作用。比较分为不同的KTR亚组：标准，拒绝的风险很高，移植物功能延迟（DGF）的高风险，活体捐赠者,老年KTR两位作者独立评估了偏倚的风险。
结果：最终纳入了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)可降低标准KTR患者2年急性排斥反应的风险(RR0.74,95CI0.61-0.89)和高排斥反应风险(RR0.55,95CI0.43-0.72),但不会降低移植物丢失的风险。我们没有发现显着差异比较ATG与阿仑单抗或任何KTR组的不同ATG剂量。
结论：尽管进行了许多关于KTR诱导治疗的研究，它们的异质性和短期随访排除了确定最佳诱导治疗的明确结论.与IL2RA相比，ATG降低了标准风险中的拒绝，高度敏感，和活体移植接受者，但不是在高DGF风险或老年接受者。需要更多的研究来证明在其他KTR亚组以及总体患者和移植物存活中的有益效果。
