Summary of findings 2. Target of rapamycin inhibitors (TOR‐I) versus calcineurin inhibitors (CNI): secondary outcomes for primary immunosuppression in kidney transplant recipients.
| TOR‐I versus CNI: outcomes up to two years (secondary 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 two years (secondary outcomes) | |||||
| Outcomes (up to 2 years for secondary 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 | ||||
| New‐onset diabetes mellitus | 60 per 1,000 | 56 per 1,000 (42 to 76) | RR 0.93 (0.69 to 1.26) | 2791 (13) | ⊕⊕⊕⊝ MODERATE 1 |
| Lymphoma/PTLD | 2 per 1,000 | 6 per 1,000 (2 to 19) | RR 2.47 (0.78 to 7.86) | 2537 (8) | ⊕⊕⊕⊝ MODERATE 1 |
| Tremor | 204 per 1,000 | 51 per 1,000 (31 to 83) | RR 0.25 (0.15 to 0.41) | 799 (6) | ⊕⊕⊕⊕ HIGH |
| GFR (mL/min) | The mean GFR was 2.2 mL/min higher with TOR‐I (1.29 lower to 5.68 higher) than CNI |
‐‐ | 2983 (15) | ⊕⊕⊝⊝ LOW 2 3 | |
| Cholesterol (mmol/L) | The mean cholesterol level was 0.77 mmol/L higher with TOR‐I (0.45 higher to 1.09 higher) than CNI |
‐‐ | 579 (7) | ⊕⊕⊝⊝ LOW 1 2 | |
| Triglycerides (mmol/L) | The mean triglyceride level 0.57 mmol/L higher with TOR‐I (0.28 higher to 0.86 higher) than CNI |
‐‐ | 843 (8) | ⊕⊕⊝⊝ LOW 1 2 | |
| Thrombocytopenia | 38 per 1,000 | 200 per 1,000 (109 to 367) | RR 5.26 (2.87 to 9.63) | 593 (4) | ⊕⊕⊝⊝ LOW 1 2 |
| *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; PTLD: post‐transplant lymphoproliferative disease; GRF: glomerular filtration rate | |||||
| 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 Small studies/ few events with wide confidence intervals
2 Unexplained heterogeneity