Summary of findings for the main comparison. Steroid withdrawal versus steroid maintenance for kidney transplant recipients.
| Steroid withdrawal versus steroid maintenance for kidney transplant recipients | |||||
| Patient or population: kidney transplant recipients Intervention: steroid withdrawal Comparison: steroid maintenance | |||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | |
| Assumed risk | Corresponding risk | ||||
| Steroid maintenance | Steroid withdrawal | ||||
| Mortality Follow‐up: 1 year | 22 per 1000 | 15 per 1000 (8 to 29) | RR 0.68 (0.36 to 1.3) | 1913 (10) | ⊕⊕⊝⊝ low1,2 |
| Graft loss (excluding death) Follow‐up: 1 year | 32 per 1000 | 38 per 1000 (23 to 62) | RR 1.17 (0.72 to 1.92) | 1817 (8) | ⊕⊕⊝⊝ low2,3 |
| Acute rejection Follow‐up: 1 year | 152 per 1000 | 268 per 1000 (182 to 396) | RR 1.77 (1.2 to 2.61) | 1913 (10) | ⊕⊕⊕⊝ moderate1 |
| NODAT Follow‐up: 5 years | 57 per 1000 | 44 per 1000 (28 to 69) | RR 0.77 (0.49 to 1.21) | 1439 (6) | ⊕⊕⊝⊝ low2,4 |
| CMV infection Follow‐up: 5 years | 100 per 1000 | 104 per 1000 (80 to 137) | RR 1.04 (0.8 to 1.36) | 1758 (5) | ⊕⊕⊝⊝ low2,5 |
| *The assumed risk is the baseline risk in the control group treated with steroid maintenance. The corresponding risk (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; NODAT: new‐onset diabetes after transplantation; CMV ‐ cytomegalovirus | |||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | |||||
1 Most studies were unblinded (9 studies) and did not report details about random sequence generation or allocation concealment or both (8 studies). One study had inappropriate random sequence generation. Four studies were industry sponsored. ITT analysis was unclear in four. 2 Total number of events were fewer than 300. 3 Most studies were unblinded (7 studies) and did not report details about random sequence generation or allocation concealment or both (6 studies). One study had inappropriate random sequence generation. Four studies were industry sponsored. ITT analysis was unclear in two. 4 Most studies were unblinded (5 studies) and did not report details about random sequence generation or allocation concealment or both (5 studies). Three studies were industry sponsored. ITT analysis was unclear in three studies. One study had selective outcome reporting. 5 Most studies were unblinded (4 studies) and did not report details about random sequence generation or allocation concealment or both (4 studies). Three studies were industry sponsored. ITT analysis was unclear in two studies. One study had selective outcome reporting.