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Various induction regimens are available for kidney transplantation (KT); however, it is unclear which is superior. Moreover, although the induction regimens are effective and important for reducing side effects, their respective relationships with antibody-mediated rejection (AMR) after transplantation remain unclear. Therefore, this study aims to elucidate the most effective induction regimen for AMR reduction through network analysis.
We performed a comprehensive search of databases including basiliximab, alemtuzumab, antithymocyte globulin (ATG), and daclizumab as induction regimens for KT from inception to September 1, 2023. Using a network meta-analysis, we investigated the priorities of five induction regimens for patient survival, graft failure, and graft rejection after ABO-incompatible KT.
In total, 25 studies comprising 1,768 people were included in this network meta-analysis. The primary outcome was the AMR rate of other induction regimes compared with that of basiliximab, while the secondary outcomes were heart failure, stroke, hospitalization, peripheral artery disease, myocardial infarction, anemia, leukopenia, herpes zoster, or adverse events. Notably, ATG reduced the AMR rate by 59% (odds ratio, 0.41; 95% credible interval, 0.20–0.90), whereas the other drugs did not show statistical significance. Furthermore, secondary outcomes did not differ significantly between the induction regimens.
ATG is widely used in KT induction regimens. Our study results showed that ATG reduced the risk of AMR in KT recipients when compared with other induction drugs; therefore, it appears to be an efficient choice of induction regimen to reduce AMR after KT.