Comparison 1. Steroid withdrawal versus steroid maintenance.

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Death and graft loss	15		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only
1.1 Death up to one year	10	1913	Risk Ratio (M‐H, Random, 95% CI)	0.68 [0.36, 1.30]
1.2 Death one to five years	7	1118	Risk Ratio (M‐H, Random, 95% CI)	1.26 [0.73, 2.17]
1.3 Graft loss including death up to one year	8	1817	Risk Ratio (M‐H, Random, 95% CI)	0.97 [0.64, 1.49]
1.4 Graft loss including death one to five years	7	1092	Risk Ratio (M‐H, Random, 95% CI)	1.41 [1.00, 2.01]
1.5 Graft loss excluding death up to one year	8	1817	Risk Ratio (M‐H, Random, 95% CI)	1.17 [0.72, 1.92]
1.6 Graft loss excluding death one to five years	7	1092	Risk Ratio (M‐H, Random, 95% CI)	1.61 [0.98, 2.64]
2 Rejection	11		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only
2.1 Acute rejection up to one year	10	1913	Risk Ratio (M‐H, Random, 95% CI)	1.77 [1.20, 2.61]
2.2 Biopsy‐proven acute rejection up to one year	5	1292	Risk Ratio (M‐H, Random, 95% CI)	1.32 [0.78, 2.22]
3 New‐onset diabetes after transplantation and cardiovascular events	6		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only
3.1 New onset diabetes after transplantation up to five years	6	1439	Risk Ratio (M‐H, Random, 95% CI)	0.77 [0.49, 1.21]
3.2 Cardiovascular events up to five years	2	607	Risk Ratio (M‐H, Random, 95% CI)	0.98 [0.42, 2.33]
4 Infection and malignancy	7		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only
4.1 Infection (all) up to five years	5	1819	Risk Ratio (M‐H, Random, 95% CI)	1.02 [0.84, 1.22]
4.2 CMV infection up to five years	5	1758	Risk Ratio (M‐H, Random, 95% CI)	1.04 [0.80, 1.36]
4.3 Malignancy up to five years	3	756	Risk Ratio (M‐H, Random, 95% CI)	0.77 [0.41, 1.46]
5 Kidney function	8		Std. Mean Difference (IV, Random, 95% CI)	Subtotals only
5.1 Serum creatinine (mg/dL) up to one year	4	644	Std. Mean Difference (IV, Random, 95% CI)	‐0.04 [‐0.21, 0.13]
5.2 Serum creatinine (mg/dL) one to five years	5	762	Std. Mean Difference (IV, Random, 95% CI)	0.08 [‐0.06, 0.23]
5.3 Creatinine clearance (mL/min) up to one year	2	215	Std. Mean Difference (IV, Random, 95% CI)	‐0.07 [‐0.35, 0.21]
5.4 Creatinine clearance (mL/min) one to five years	3	669	Std. Mean Difference (IV, Random, 95% CI)	‐0.21 [‐0.56, 0.13]