Five RCTs (n=215; 105 treated with ATG and 110 with OKT3) were included in the review.
Only one trial was rated as high quality (3 out of 5); other trials scored 2 out of 5 as they did not use blinding.
There was no statistically significant difference between ATG and OKT3 for the mean time to first rejection episode (5 studies; WMD 6.73, 95% CI: -8.75, 22.21). Heterogeneity was statistically significant (P<0.00001). There was no statistically significant difference between treatment groups for the number of patients with rejection at 6 months (3 studies). One study showed a higher incidence of rejection in the ATG group relative to the OKT3 group, whereas another study showed no difference between the groups at 6 months.
There was no statistically significant difference between treatment groups in the number of patients who developed infection in the first 6 months (4 studies) or in the number of infection episodes per patient (1 study).
There was no statistically significant difference between groups in survival up to 1 year after transplantation (4 studies).
Most studies reported higher rates of drug -elated complications in the OKT3 group relative to the ATG group. These side-effects included fever, headache, acute respiratory distress and hypotension.
All included studies had equivalent quality scores so a sensitivity analysis on study quality was not carried out.