Schulak 1989.

Methods	Study design: parallel RCT Time frame: 1987 to 1989 Follow‐up period: 2 years
Participants	Country: USA Setting: single centre First and second cadaveric or living kidney transplant Number (randomised/analysed): withdrawal group 32/32); maintenance group (35/35) Mean age ± SD (years): withdrawal group (44 ± 13); maintenance group (43 ± 12) Sex (female): withdrawal group (50%); maintenance group (34%) Donor source (living donors): withdrawal group (16%); maintenance group (9%) Exclusion criteria: previous graft lost due to rejection; ongoing steroid therapy for other diseases
Interventions	Treatment group Steroid withdrawal after 6 to 20 days after transplantation (most had steroids < 14 days), steroids were withdrawn shortly after CsA initiation Control group Steroid maintenance Baseline immunosuppression ALG: 10 mg/kg day 1; 20 mg/kg day 5 to 12 depending on graft function CsA: starting on last day of ALG administration with 10 mg/kg/d adjusted to blood levels between 100 to 250 ng/mL during first 3 months; tapered to 3 to 5 mg/kg/d by 6 months AZA: 5 mg/kg once prior to transplantation; 1.5 to 2.0 mg/kg daily after transplantation Steroids IV methylprednisone: day 0: 250 mg; day 1 to 3: tapered doses Oral prednisone: day 4: 1mg/kg/d; tapered to 30 mg/d by week 2; tapered to 15 mg/d at month 3 to 4
Outcomes	Mortality Graft loss Acute rejection Infection SCr (mg/dL)
Notes	Did not report number screened for eligibility Number of patients discontinued treatment Withdrawal group: returned to steroid maintenance (18)
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	'Patients were randomised using a table of random numbers'
Allocation concealment (selection bias)	Unclear risk	Not reported
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	Low risk	All patients followed up or accounted for; ITT analysis performed
Selective reporting (reporting bias)	Low risk	Primary outcomes for this review reported
Other bias	Unclear risk	Groups at baseline were different regarding gender, race and causes of kidney failure with more females, less African‐Americans, more diabetics in the steroid avoidance group Funding source not reported