Summary of findings 5. Variable target of rapamycin inhibitor (TOR‐I) and calcineurin inhibitor (CNI): primary outcomes for primary immunosuppression in kidney transplant recipients.
| Variable TOR‐I and CNI: primary outcomes for primary immunosuppression in kidney transplant recipients | |||||
| Patient or population: primary immunosuppression in kidney transplant recipients Setting: kidney transplant centres Intervention: lower dose TOR‐I and standard CNI Comparison: higher dose TOR‐I and reduced 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 higher dose TOR‐I | Risk with low dose TOR‐I | ||||
| Death (all causes) | 39 per 1,000 | 41 per 1,000 (25 to 69) | RR 1.07 (0.64 to 1.78) | 1501 (9) | ⊕⊕⊕⊝ MODERATE 1 |
| Graft loss (censored) | 36 per 1,000 | 39 per 1,000 (19 to 79) | RR 1.09 (0.54 to 2.20) | 1385 (8) | ⊕⊕⊕⊝ MODERATE 1 |
| Biopsy‐proven acute rejection | 155 per 1,000 | 135 per 1,000 (104 to 175) | RR 0.87 (0.67 to 1.13) | 1381 (8) | ⊕⊕⊕⊝ MODERATE 1 |
| CMV infection | 40 per 1,000 | 57 per 1,000 (32 to 105) | RR 1.42 (0.78 to 2.60) | 865 (5) | ⊕⊕⊕⊝ MODERATE 2 |
| Adverse wound outcomes: all complications | 135 per 1,000 | 128 per 1,000 (72 to 231) | RR 0.95 (0.53 to 1.71) | 291 (3) | ⊕⊕⊝⊝ LOW 3 |
| All malignancies | 15 per 1,000 | 16 per 1,000 (5 to 46) | RR 1.04 (0.36 to 3.04) | 1163 (7) | ⊕⊕⊝⊝ LOW 1 |
| Number needing to change treatment | 186 per 1,000 | 219 per 1,000 (108 to 450) | RR 1.18 (0.58 to 2.42) | 734 (5) | ⊕⊕⊝⊝ LOW 4 |
| *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). 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
2 Few events in only five studies; wide confidence intervals
3 Only reported in three studies; wide confidence intervals
4 Significant heterogeneity