Summary of findings for the main comparison. Glucocorticosteroid avoidance or withdrawal compared to glucocorticosteroid‐based immunosuppression for liver transplanted patients.
| Glucocorticosteroid avoidance or withdrawal compared to glucocorticosteroid‐based immunosuppression for liver transplanted patients | ||||||
| Patient or population: liver transplanted patients Setting: inpatient and outpatient Intervention: glucocorticosteroid avoidance or withdrawal Comparison: glucocorticosteroid‐based immunosuppression | ||||||
| Outcomes** | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (trials) | Quality of the evidence (GRADE) | Comments | |
| Risk with glucocorticosteroid‐based immunosuppression | Risk with glucocorticosteroid avoidance or withdrawal | |||||
| All‐cause mortality | Study population | RR 1.15 (0.93 to 1.44) | 1323 (15 RCTs) | ⊕⊕⊝⊝ LOW 1,2 | The quality of the evidence was considered low for both glucocorticosteroid avoidance and glucocorticosteroid withdrawal. Trial Sequential Analysis‐adjusted CI 0.77‐1.66. | |
| 166 per 1000 | 191 per 1000 (154 to 239) | |||||
| Moderate | ||||||
| 204 per 1000 | 234 per 1000 (189 to 293) | |||||
| Graft loss including death | Study population | RR 1.15 (0.90 to 1.46) | 1002 (11 RCTs) | ⊕⊕⊝⊝ LOW 1, 2 | The quality of the evidence was considered low for both glucocorticosteroid avoidance and glucocorticosteroid withdrawal. Trial Sequential Analysis‐adjusted CI 0.75‐2.01. | |
| 175 per 1000 | 203 per 1000 (159 to 259) | |||||
| Moderate | ||||||
| 218 per 1000 | 253 per 1000 (198 to 322) | |||||
| Acute rejection | Study population | RR 1.33 (1.08 to 1.64) | 1347 (16 RCTs) | ⊕⊕⊝⊝ LOW 1,2 | The quality of the evidence was considered low both glucocorticosteroid avoidance and glucocorticosteroid withdrawal. Trial Sequential Analysis‐adjusted CI 0.92‐1.90. | |
| 173 per 1000 | 230 per 1000 (187 to 283) | |||||
| Moderate | ||||||
| 194 per 1000 | 257 per 1000 (209 to 317) | |||||
| Infection | Study population | RR 0.88 (0.73 to 1.05) | 778 (8 RCTs) | ⊕⊝⊝⊝ VERY LOW 1, 2, 3 | The quality of the evidence was considered very low for both glucocorticosteroid avoidance and glucocorticosteroid withdrawal. Trial Sequential Analysis‐adjusted CI 0.49‐1.71. | |
| 359 per 1000 | 316 per 1000 (262 to 377) | |||||
| Moderate | ||||||
| 402 per 1000 | 354 per 1000 (293 to 422) | |||||
| *The risk in the intervention group (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).
**We assessed all outcomes at latest follow‐up (range 13 months to 108 months). CI: confidence interval; RR: risk ratio; RCT: randomised clinical trial | ||||||
| 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 | ||||||
1Downgraded one level due to risk of bias: all trials were at high risk of bias. 2Downgraded one level due to imprecision identified in the Trial Sequential Analysis; 95% CI includes both benefit and harm. 3Downgraded one level due to significant heterogeneity identified between subgroups; avoidance versus withdrawal.