Nematalla 2007.

Methods	Study design: parallel RCT Time frame: 2004 to 2005 Follow‐up period: 1 year Primary endpoint: incidence of biopsy‐proven acute rejection within 12 months after transplantation
Participants	Country: Egypt Setting: single centre First living kidney transplant; recipient age 22 to 56 years; donor age 21 to 60 years Number (randomised/analysed): withdrawal group (50/50); maintenance group (50/50) Mean age ± SD (years): withdrawal group (30 ± 11); maintenance group (29 ± 10) Sex (female): withdrawal group (20%); maintenance group (36%) Exclusion criteria: mismatch at HLA‐DR locus
Interventions	Treatment group Steroid withdrawal day 4 after transplantation (if TAC levels in target range) Control group Steroid maintenance Baseline immunosuppression Basiliximab: day 0 and 4: 20 mg TAC: starting on day ‐2 with 0.1 mg/kg/d adjusted to trough levels week 1 to 2: 10‐15 ng/mL; thereafter: 5 to 10 ng/mL MMF: week 1 to 2: 1000 mg twice daily; thereafter 750 mg twice daily Steroids IV methylprednisone: day 0: 500 mg Withdrawal group: methylprednisone: day 1: 500 mg; day 2: 250 mg; day 3: 100 mg; thereafter no further steroids Maintenance group: methylprednisone: day 1, 3, 7, 14: 3.5 mg/kg/d; followed by gradual tapering to 0.15 mg/kg/d by month 9
Outcomes	Mortality Graft loss Biopsy‐proven acute rejection NODAT Infection CMV infection SCr (µmol/L) eGFR (mL/min)
Notes	Did not report number screened for eligibility Contact with study authors for additional information: authors contacted 9 July 2013; no response received
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	'100 similar closed opaque envelopes were made, each containing a slip of opaque paper with the type of maintenance immunosuppression. Therefore, 50 envelopes were with steroid and the rest were without. All envelopes were kept closed until the morning of the transplant day, when one envelope was selected for each patient'.
Allocation concealment (selection bias)	Low risk	'Similar closed opaque envelopes, each containing a slip of opaque paper'.
Blinding (performance bias and detection bias) All outcomes	High risk	Open‐label
Blinding of participants and personnel (performance bias) All outcomes	High risk	Open‐label
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Outcomes are objective hard endpoints
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Unclear whether ITT analysis performed; number of patients in groups varies slightly between reports
Selective reporting (reporting bias)	Low risk	Primary outcomes for this review reported
Other bias	Unclear risk	Different protocol between groups for steroid dosing before withdrawal Funding source not reported