for the main comparison.
| ATG compared with placebo or no induction for kidney transplant recipients | ||||||
|
Patient or population: kidney transplant recipients Settings: Intervention: ATG Comparison: placebo/no treatment | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Placebo/no treatment | ATG | |||||
|
Death (including CNI) Follow‐up: median 24 months (IQR 12‐24) |
Medium risk population |
RR 0.75 (0.27 to 2.06) |
632 (5) | ⊕⊕⊝⊝ low1,2 | ||
| 31 per 1000 | 23 per 1000 (8 to 64) | |||||
|
All‐cause graft loss (including CNI) Follow‐up: median 1 year (IQR 12‐24) |
Medium risk population |
RR 0.65 (0.36 to 1.19) |
549 (3) | ⊕⊕⊝⊝ low1,2 | ||
| 109 per 1000 | 71 per 1000 (39 to 129) | |||||
|
Delayed graft function Follow‐up: N/A (immediate) |
Medium risk population | RR 0.93 (0.78 to 1.10) | 1304 (9) | ⊕⊕⊝⊝ low1,2 | ||
| 283 per 1000 | 263 per 1000 (221 to 311) | |||||
|
Acute rejection (including CNI) Follow‐up: median 1 year (IQR 6‐24) |
Medium risk population |
RR 0.61 (0.49 to 0.76) |
1491 (12) | ⊕⊕⊕⊝ moderate1 | ||
| 365 per 1000 | 222 per 1000 (179 to 277) | |||||
|
Infection: CMV infection Follow‐up: median 1 year (IQR 4.5‐13.5) |
Medium risk population |
RR 1.55 (1.24 to 1.95) |
1072 (6) | ⊕⊕⊕⊝ moderate1 | ||
| 176 per 1000 | 273 per 1000 (218 to 343) | |||||
|
Malignancy Follow‐up: median 18 months (IQR 12‐60) |
Medium risk population |
RR 0.94 (0.30 to 2.94) |
891 (7) | ⊕⊕⊝⊝ low1,2,3 | ||
| 15 per 1000 | 14 per 1000 (5 to 44) | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval: RR: Risk Ratio; IQR: interquartile range. | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 At risk of selection bias as more than 50% of studies rated as allocation concealment and/or random sequence generation unclear or high risk of causing bias.
2 Confidence interval includes range of plausible values below clinical significance or including harm.
3Based on few events across all studies.