Safety and efficacy of preoperative induction therapy using a single high dose ATG-F in renal transplantation: a meta-analysis of randomized controlled trials

Abstract

This study aimed to evaluate the safety and efficacy of preoperative induction therapy using a single high dose (9 mg/kg) of antithymocyte globulin-Fresenius S (ATG-F) for patients undergoing renal transplantation. Randomized controlled clinical trials (RCTs) on the safety and efficacy of preoperative induction therapy using a single high dose of ATG-F for patients undergoing renal transplantation were searched in Cochrane Library, PubMed, EMBASE covering a period from the beginning of databases to July 2015. The meta-analysis was conducted using RevMan 5.2. Five RCTs with 346 patients were included in this study. The meta-analysis showed that the incidences of acute rejection for the patients with renal transplantation were 20.6% (37/180) in the induction therapy group using a single high dose of ATG and 42.8% (71/166) in the control group, with a combined relative risk (RR) of 0.49 and 95% confidence interval (CI) of[0.36, 0.69](P<0.000 1). The patient survival rate (1 year: RR=1.02, 95% CI[0.98, 1.06], P=0.43; 5 years: RR=1.01, 95% CI[0.94, 1.08], P=0.83) and the graft survival rate (RR=1.04, 95% CI[0.97, 1.12], P=0.24) of the two groups were similar. The incidences of CMV infection, urinary tract infection, and malignant tumor were also similar in the two groups. The induction therapy using a single high dose of ATG-F significantly reduced the incidence of acute rejection after transplantation and showed no increased incidence of urinary tract infection, CMV infection, or malignant tumor. The results of our meta-analysis suggest that the application of a high dose of ATG-F may be a safe and effective induction therapy.