Summary of findings for the main comparison. Target of rapamycin inhibitors (TOR‐I) versus calcineurin inhibitors (CNI): main outcomes for primary immunosuppression in kidney transplant recipients.
| TOR‐I versus CNI: outcomes up to 2 years (main outcomes) for primary immunosuppression in kidney transplant recipients | |||||
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Patient or population: primary immunosuppression in kidney transplant recipients
Setting: kidney transplant services Intervention: TOR‐I Comparison: CNI | |||||
| Outcomes (up to 2 years for primary outcomes) | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Certainty of the evidence (GRADE) | |
| Risk with CNI | Risk with TOR‐I | ||||
| Death (all causes) | 25 per 1,000 | 33 per 1,000 (22 to 50) | RR 1.31 (0.87 to 1.98) | 3618 (19) | ⊕⊕⊕⊝ MODERATE 1 |
| Graft loss censored for death | 51 per 1,000 | 68 per 1,000 (49 to 93) | RR 1.32 (0.96 to 1.81) | 3277 (14) | ⊕⊕⊕⊝ MODERATE 1 |
| Biopsy‐proven acute rejection | 196 per 1,000 | 333 per 1,000 (258 to 429) | RR 1.70 (1.32 to 2.19) | 3309 (15) | ⊕⊕⊕⊝ MODERATE1 |
| CMV infection | 157 per 1,000 | 68 per 1,000 (46 to 99) | RR 0.43 (0.29 to 0.63) | 2026 (13) | ⊕⊕⊕⊕ HIGH |
| Adverse wound outcomes: all complications | 77 per 1,000 | 198 per 1,000 (150 to 260) | RR 2.56 (1.94 to 3.36) | 1679 (12) | ⊕⊕⊕⊝ MODERATE 1 |
| All malignancies | 24 per 1,000 | 20 per 1,000 (12 to 35) | RR 0.86 (0.50 to 1.48) | 2584 (10) | ⊕⊕⊕⊝ MODERATE 1 |
| Number needing to change treatment | 132 per 1,000 | 320 per 1,000 (249 to 412) | RR 2.42 (1.88 to 3.11) | 3148 (14) | ⊕⊕⊕⊝ MODERATE 1 |
| *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; CMV: cytomegalovirus | |||||
| GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: 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 certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | |||||
1 few events leading to wide confidence intervals