ABSTRACT

Background

This systematic review and meta-analysis were performed to explore the association between rabbit thymoglobulin (rATG) doses and transplant-related efficacy and safety outcomes.

Methods

We searched PubMed and Scopus databases from inception up to June 2020. The primary efficacy and safety endpoints in kidney transplant recipients were evaluated.

Results

Data of 23 cohort studies (3457 patients) and three RCTs (154 patients) were extracted and analyzed. rATG doses of ≤4.5 m/kg was associated with lower rates of biopsy proven acute rejection, cytomegalovirus infection, BK virus infection, and malignancy with a comparable rate of delayed graft function, patients’ mortality, and death-censored graft loss compared to rATG total doses of 4.5–6 mg/kg or more than 6 mg/kg. The rATG doses of 3–4.5 mg/kg was associated with better outcomes in dose–response analysis.

Expert opinion

Cumulative rATG induction doses as much as 3–4.5 mg/kg is as effective as higher doses regarding to allograft and patient outcomes while minimizing potential adverse effects in kidney transplant recipients.

中文翻译：

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肾移植患者累积 rATG 诱导剂量与肾移植结果和不良反应之间的关联：系统评价和荟萃分析

摘要

背景

这项系统回顾和荟萃分析旨在探索兔胸腺球蛋白 (rATG) 剂量与移植相关疗效和安全性结果之间的关联。

方法

我们检索了 PubMed 和 Scopus 数据库从开始到 2020 年 6 月。评估了肾移植受者的主要疗效和安全性终点。

结果

提取和分析了 23 项队列研究（3457 名患者）和 3 项 RCT（154 名患者）的数据。与 rATG 相比，rATG 剂量≤4.5 m/kg 与活检证实的急性排斥反应、巨细胞病毒感染、BK 病毒感染和恶性肿瘤的发生率较低相关，移植物功能延迟率、患者死亡率和死亡审查移植物丢失率相当总剂量为 4.5–6 mg/kg 或超过 6 mg/kg。3-4.5 mg/kg 的 rATG 剂量与剂量反应分析中更好的结果相关。

专家意见

就同​​种异体移植物和患者结局而言，高达 3-4.5 mg/kg 的累积 rATG 诱导剂量与更高剂量一样有效，同时将肾移植受者的潜在不良影响降至最低。