Summary of findings 6. Variable target of rapamycin inhibitor (TOR‐I) and calcineurin inhibitor (CNI): secondary outcomes for primary immunosuppression in kidney transplant recipients.
| Variable TOR‐I and CNI: secondary 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 secondary 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 lower dose TOR‐I | ||||
| New‐onset diabetes mellitus: TAC | 57 per 1,000 | 102 per 1,000 (56 to 183) | RR 1.79 (0.99 to 3.23) | 580 (5) | ⊕⊕⊝⊝ LOW 1 2 |
| New‐onset diabetes mellitus: CSA | 63 per 1,000 | 36 per 1,000 (17 to 75) | RR 0.57 (0.27 to 1.20) | 606 (3) | ⊕⊕⊝⊝ LOW 1 2 |
| GFR (mL/min) | The mean GFR was 5.96 mL/min lower with low dose TOR‐I (9.54 lower to 2.38 lower) compared to higher dose TOR‐I | ‐‐ | 1305 (7) | ⊕⊕⊝⊝ LOW1 3 | |
| Hypercholesterolaemia | 251 per 1,000 | 241 per 1,000 (188 to 307) | RR 0.96 (0.75 to 1.22) | 734 (4) | ⊕⊕⊕⊝ MODERATE 2 |
| Hypertriglyceridaemia | 521 per 1,000 | 443 per 1,000 (380 to 526) | RR 0.85 (0.73 to 1.01) | 734 (4) | ⊕⊕⊕⊝ MODERATE 2 |
| Anaemia | 339 per 1,000 | 315 per 1,000 (271 to 366) | RR 0.93 (0.80 to 1.08) | 1074 (6) | ⊕⊕⊕⊝ MODERATE 2 |
| Leucopenia | 107 per 1,000 | 106 per 1,000 (75 to 150) | RR 0.99 (0.70 to 1.40) | 1012 (5) | ⊕⊕⊕⊝ MODERATE2 |
| *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; TAC: tacrolimus; CSA: cyclosporin; GFR: 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 Few events leading to wide confidence intervals
2 Over 50% of included studies have unclear sequence generation and allocation concealment
3 Significant heterogeneity