LAUSR

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.