Comparison 3. Alemtuzumab + early steroid withdrawal (ESW) or minimisation versus ATG ± ESW.

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Death and graft loss	6		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only
1.1 Death at 1 year	2	41	Risk Ratio (M‐H, Random, 95% CI)	0.39 [0.06, 2.42]
1.2 Death at 2 to 3 years	3	225	Risk Ratio (M‐H, Random, 95% CI)	0.67 [0.15, 2.95]
1.3 Graft loss (all cause) at 1 year	2	41	Risk Ratio (M‐H, Random, 95% CI)	0.39 [0.12, 1.30]
1.4 Graft loss (all cause) at 2 to 3 years	3	379	Risk Ratio (M‐H, Random, 95% CI)	0.98 [0.47, 2.06]
1.5 Graft loss (death censored) at 1 year	2	37	Risk Ratio (M‐H, Random, 95% CI)	0.38 [0.08, 1.81]
1.6 Graft loss (death censored) at 2 to 3 years	2	186	Risk Ratio (M‐H, Random, 95% CI)	2.45 [0.67, 8.97]
1.7 Delayed graft function	2	86	Risk Ratio (M‐H, Random, 95% CI)	0.62 [0.13, 3.07]
2 Rejection	6		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only
2.1 Acute rejection at 3 to 6 months (ESW both arms)	3	341	Risk Ratio (M‐H, Random, 95% CI)	0.47 [0.17, 1.30]
2.2 Acute rejection ≥ 1 year (all studies)	6	446	Risk Ratio (M‐H, Random, 95% CI)	0.68 [0.44, 1.05]
2.3 Acute rejection ≥ 1 year (ESW both arms)	4	360	Risk Ratio (M‐H, Random, 95% CI)	0.57 [0.35, 0.93]
2.4 Acute rejection ≥ 1 year (ESW with alemtuzumab only)	2	86	Risk Ratio (M‐H, Random, 95% CI)	1.27 [0.50, 3.19]
2.5 CAN (biopsy proven) (ESW with alemtuzumab only)	2	86	Risk Ratio (M‐H, Random, 95% CI)	2.45 [1.02, 5.94]
3 Infection	4		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only
3.1 All cause (moderate‐severe)	4	247	Risk Ratio (M‐H, Random, 95% CI)	0.94 [0.63, 1.41]
3.2 CMV infection	3	225	Risk Ratio (M‐H, Random, 95% CI)	1.08 [0.46, 2.56]
3.3 BK virus infection	2	86	Risk Ratio (M‐H, Random, 95% CI)	3.0 [0.13, 70.83]
4 Other adverse effects	4		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only
4.1 Leucopenia at 1 month	1	60	Risk Ratio (M‐H, Random, 95% CI)	21.0 [1.29, 342.93]
4.2 Leucopenia at 2 years	1	53	Risk Ratio (M‐H, Random, 95% CI)	3.12 [0.35, 28.06]
4.3 NODAT	2	69	Risk Ratio (M‐H, Random, 95% CI)	0.41 [0.12, 1.40]
4.4 Malignancy	3	187	Risk Ratio (M‐H, Random, 95% CI)	4.93 [0.59, 41.11]
4.5 PTLD	2	165	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
4.6 Cytokine release syndrome	1	22	Risk Ratio (M‐H, Random, 95% CI)	0.2 [0.01, 3.74]
4.7 Any serious adverse event	1	139	Risk Ratio (M‐H, Random, 95% CI)	0.81 [0.59, 1.12]
5 Creatinine clearance	2		Mean Difference (IV, Random, 95% CI)	Subtotals only
5.1 At 6 months	2	83	Mean Difference (IV, Random, 95% CI)	‐13.35 [‐23.91, ‐2.80]
5.2 At 24 months	2	77	Mean Difference (IV, Random, 95% CI)	‐12.86 [‐23.73, ‐2.00]