Summary of findings 4. Low dose CNI calcineurin inhibitor (CNI) + mammalian target of rapamycin inhibitor (mTORi) versus standard dose CNI for kidney transplant recipients.
| Low dose CNI + mTORi versus standard dose CNI for kidney transplant recipients | |||||
| Patient or population: kidney transplant recipients Intervention: low dose CNI + mTORi Comparison: standard dose CNI | |||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Quality of the evidence (GRADE) | |
| Risk with standard dose CNI | Risk with low dose CNI + mTORi | ||||
| Death Follow‐up: range 6 months to 3 years | Study population | RR 1.16 (0.71 to 1.90) | 2750 (11) | ⊕⊕⊕⊝ MODERATE 1 2 3 4 | |
| 22 per 1,000 | 26 per 1,000 (16 to 42) | ||||
| Acute rejection Follow‐up: range 6 months to 3 years | Study population | RR 1.13 (0.91 to 1.40) | 3300 (16) | ⊕⊕⊕⊝ MODERATE 2 4 | |
| 132 per 1,000 | 149 per 1,000 (120 to 185) | ||||
| GFR Follow‐up: range 6 months to 2 years | The mean GFR in the intervention group was 6.24 mL/min more (3.28 more to 9.19 more) than the control group | ‐ | 1749 (11) | ⊕⊕⊕⊝ MODERATE 5 | |
| Graft loss Follow‐up: range 6 months to 3 years | Study population | RR 0.67 (0.45 to 1.01) | 3304 (16) | ⊕⊕⊕⊝ MODERATE 2 6 | |
| 38 per 1,000 | 25 per 1,000 (17 to 38) | ||||
| Adverse events: hypertension Follow‐up: range 6 months to 2 years | Study population | RR 0.98 (0.80 to 1.20) | 1421 (5) | ⊕⊕⊝⊝ LOW 7 8 | |
| 203 per 1,000 | 199 per 1,000 (162 to 243) | ||||
| Adverse events: CMV infection Follow‐up: range 1 to 3 years | Study population | RR 0.41 (0.16 to 1.06) | 1250 (5) | ⊕⊕⊝⊝ LOW 5 7 9 | |
| 105 per 1,000 | 43 per 1,000 (17 to 111) | ||||
| Adverse events: malignancy Follow‐up: range 1 to 3 years | Study population | RR 1.22 (0.42 to 3.52) | 1074 (5) | ⊕⊕⊝⊝ LOW 2 4 7 | |
| 11 per 1,000 | 14 per 1,000 (5 to 40) | ||||
| *The risk in the intervention group (and its 95% CI) 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 | |||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | |||||
1 Randomisation and allocation process not clear in some studies
2 No significant heterogeneity
3 Only 2 of the studies had more than 2 comparisons
4 Some small studies with wide CI
5 Substantial heterogeneity noted due to recording at different time periods
6 Small number of events and some small studies with wide CI
7 Only few studies reported this outcome
8 95% CI fails to exclude benefit or harm
9 Heterogeneity present but when abstract only studies are removed, heterogeneity is zero