Background: Thymoglobulin (THG) and antithymocyte globulin-Fresenius (ATG-F) have not been compared directly as induction therapies in kidney transplantation. Materials and Methods: 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. Results: 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%), de novo 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%). Conclusion: 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.

中文翻译：

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胸腺球蛋白对ATG-费森尤斯作为肾脏移植的诱导疗法：随机对照试验的贝叶斯网络Meta分析。

背景：胸腺球蛋白（THG）和抗胸腺细胞球蛋白-Fresenius（ATG-F）尚未直接比较作为肾移植的诱导疗法。材料和方法：我们进行了贝叶斯网络荟萃分析，通过收集直接和间接证据比较THG和ATG-F。使用累积排名曲线下的曲面（SUCRA）值来比较一种方法相对于另一种方法的优越性。结果：总共27项随机对照试验（RCT）有资格进行网络荟萃分析。功效终点和安全指标在统计​​学上可比。对于功效终点，THG在防止移植物功能延迟方面似乎不如ATG-F [优势比（OR）：1.27；SUCRA：78％vs. 58％]，患者死亡（OR：2.78； SUCRA：83％vs. 34％）和移植物丢失（OR：1.40； SUCRA：83％vs. 59％），但在活检证实的急性排斥反应方面（BPAR; OR：0.59; SUCRA：78％vs. 39％）和对类固醇耐药的BPAR预防（OR：0.61; SUCRA：76％vs. 49％）优于ATG-F第一年。对于安全性终点，THG与较高的感染风险（OR：1.49，SUCRA：79％比54％），巨细胞病毒感染（OR：1.04； SUCRA：40％比37％），新发糖尿病（OR：与ATG-F相比，SUCRA：1.10； SUCRA：90％对30％）和恶性肿瘤（OR：8.40； SUCRA：89％对6％）。对免疫并发症高风险患者进行的亚组分析显示了相似的结果，但THG移植物丢失表现更好（OR：0.82； SUCRA：68％比54％）。结论：ATG-F在改善短期肾脏移植结局方面似乎比THG更有效。