Transplant Trial Watch

Effectiveness of Antithymocyte Globulin Induction Dosing Regimens in Kidney Transplantation Patients: A Network Meta-analysis.

Lee, J. H., Kim, K. Y. et al. (2019).

Transplantation Proceedings [record in progress].

This study aimed to identify the most effective method of induction immunosuppression in kidney transplantation using dosing regimens of Antithymocyte Globulin (ATG).

The CENTRAL, Medline, EMBASE and Science Cittion Index Expanded databases were searched for reports on ATG dosage and injection number variations. The ATG dose and administration schedule in kidney transplantation was compared.

Ten studies (Nā€‰=ā€‰1065) were analyzed by forming 6 groups: ATG alternate doses, 9 mg/kg, 6 mg/kg, and 4.5 mg/kg; single dose, 6 mg/kg, and 4.5 mg/kg; and control.

Primary outcomes of this study was graft rejection. Whereas, secondary otucomes incuded: patient and graft survival, all-cause death, antibody-mediated rejection, T-cell mediated rejection, biopsy-proven acute rejecion and bacterial and viral infection.


CET Conclusions
This systematic review and network meta-analysis attempts to look a different ATG dosing strategies in renal transplant recipients in relation to post-transplant outcomes. The authors identify 10 randomised controlled trials with 6 different dosing regimens. They bravely conclude that induction with 4.5 and 9 mg ATG on alternative days were most effective at preventing rejection with low risk of infection. The small number of studies for each dose strategy means that this conclusion cannot be supported by the evidence presented. It is not exactly clear from the manuscript how many studies contributed to each 2-way comparison, and which comparisons were based on direct versus indirect evidence. It is also not made clear whether indirect and direct comparisons are consistent with one another. Heterogeneity is not reported. Confidence intervals are wide, and none of the individual comparisons reach statistical significance meaning that the review is inconclusive.

Quality notes
SR - QA not necessary.

Trial registration

Funding source
Not reported