Comparison of induction therapy with anti-thymocyte/antilymphocyte globulin or anti-IL-2 receptor antibody in pediatric kidney transplantation: a systematic review and meta-analysis

Abstract

BackgroundAnti-IL-2 antibody (basiliximab or daclizumab) and anti-thymocyte globulin (ATG)/antilymphocyte globulin (ALG) are widely used as induction agents in pediatric kidney transplantation. However, which of them benefits patients more remains unknown.MethodsOnline databases were searched to identify controlled clinical studies that compared anti-IL-2 with ATG/ALG for induction therapy in pediatric kidney transplantation. Odds ratios (OR) and 95% confidence interval (CI) were chosen to compare the gathered data. Review Manager 5.4 was applied to identify differences in outcomes between the two agents.ResultsFive retrospective cohort studies were included, enrolling a total of 2510 pediatric patients, 1152 (45.7%) of whom had received ATG/ALG therapy and 1370 (54.3%) of whom received anti-IL-2. According to the pooled results, no differences were seen between anti-IL-2 and ATG/ALG regarding the delayed graft function (DGF) rate (odds ratio (OR) 1.1; 95% confidence interval (CI) 0.36–3.39; P = 0.85), 6-month acute rejection rate (OR 0.80; 95% CI 0.62–1.03; P = 0.09), 1-year acute rejection rate (OR 0.98; 95% CI 0.78–1.24; P = 0.88), 1-year graft survival rate (OR 1.37; 95% CI 0.91–2.06; P = 0.13), 1-year patient survival rate (OR 0.86; 95% CI 0.40–1.86; P = 0.70) and 1-year post-transplantation lymphoproliferative disorder (PTLD) rate (OR 0.30; 95% CI 0.03–3.16; P = 0.32).ConclusionsAnti-IL-2 have the same efficacy and safety as ATG/ALG in transplant induction therapy. However, as most of included studies were small-scale retrospective studies, further studies are needed to identify an optimal choice with certain.The analysis had been registered in PROSPERO and the registration ID is CRD42021237561. Comparison of induction therapy with anti-thymocyte/antilymphocyte globulin or anti-IL-2 receptor antibody in pediatric kidney transplantation: a systematic review and meta-analysis