Cochrane · systematic review · CD004290
Target of rapamycin inhibitors (TOR‐I; sirolimus and everolimus) for primary immunosuppression in kidney transplant recipients
Hahn, D, Hodson, EM, Hamiwka, LA, et al. · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library
Kidney and TransplantAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
61
current version
GRADE rated
55
No studies
6
Included studies
NR
No studies 6 · 9.8%Ungraded 0 · 0%Very low 0 · 0%Low 18 · 29.5%Moderate 34 · 55.7%High 3 · 4.9%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Target of rapamycin inhibitors (TOR‐I) versus calcineurin inhibitors (CNI): main outcomes for primary immunosuppression in kidney transplant recipients
Population: primary immunosuppression in kidney transplant recipients
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcomes (up to 2 years for primary outcomes) Target of rapamycin inhibitors (TOR‐I) vs calcineurin inhibitors (CNI): main outcomes | no estimate extracted | NR | No studies |
Death (all causes) Target of rapamycin inhibitors (TOR‐I) vs calcineurin inhibitors (CNI): main outcomes | RR 1.31 [0.87, 1.98] | 19 studies · 3618 participants | Moderate Downgraded: imprecision |
Graft loss censored for death Target of rapamycin inhibitors (TOR‐I) vs calcineurin inhibitors (CNI): main outcomes | RR 1.32 [0.96, 1.81] | 14 studies · 3277 participants | Moderate Downgraded: imprecision |
Biopsy‐proven acute rejection Target of rapamycin inhibitors (TOR‐I) vs calcineurin inhibitors (CNI): main outcomes | RR 1.7 [1.32, 2.19] | 15 studies · 3309 participants | Moderate Downgraded: imprecision |
CMV infection Target of rapamycin inhibitors (TOR‐I) vs calcineurin inhibitors (CNI): main outcomes | RR 0.43 [0.29, 0.63] | 13 studies · 2026 participants | High |
Adverse wound outcomes: all complications Target of rapamycin inhibitors (TOR‐I) vs calcineurin inhibitors (CNI): main outcomes | RR 2.56 [1.94, 3.36] | 12 studies · 1679 participants | Moderate Downgraded: imprecision |
All malignancies Target of rapamycin inhibitors (TOR‐I) vs calcineurin inhibitors (CNI): main outcomes | RR 0.86 [0.5, 1.48] | 10 studies · 2584 participants | Moderate Downgraded: imprecision |
Number needing to change treatment Target of rapamycin inhibitors (TOR‐I) vs calcineurin inhibitors (CNI): main outcomes | RR 2.42 [1.88, 3.11] | 14 studies · 3148 participants | Moderate Downgraded: imprecision |
Target of rapamycin inhibitors (TOR‐I) versus calcineurin inhibitors (CNI): secondary outcomes for primary immunosuppression in kidney transplant recipients
Population: primary immunosuppression in kidney transplant recipients
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcomes (up to 2 years for secondary outcomes) Target of rapamycin inhibitors (TOR‐I) vs calcineurin inhibitors (CNI): secondary outcomes | no estimate extracted | NR | No studies |
New‐onset diabetes mellitus Target of rapamycin inhibitors (TOR‐I) vs calcineurin inhibitors (CNI): secondary outcomes | RR 0.93 [0.69, 1.26] | 13 studies · 2791 participants | Moderate Downgraded: imprecision |
Lymphoma/PTLD Target of rapamycin inhibitors (TOR‐I) vs calcineurin inhibitors (CNI): secondary outcomes | RR 2.47 [0.78, 7.86] | 8 studies · 2537 participants | Moderate Downgraded: imprecision |
Tremor Target of rapamycin inhibitors (TOR‐I) vs calcineurin inhibitors (CNI): secondary outcomes | RR 0.25 [0.15, 0.41] | 6 studies · 799 participants | High |
GFR (mL/min) Target of rapamycin inhibitors (TOR‐I) vs calcineurin inhibitors (CNI): secondary outcomes | no estimate extracted | 15 studies · 2983 participants | Low Downgraded: imprecision, inconsistency |
Cholesterol (mmol/L) Target of rapamycin inhibitors (TOR‐I) vs calcineurin inhibitors (CNI): secondary outcomes | no estimate extracted | 7 studies · 579 participants | Low Downgraded: imprecision |
Triglycerides (mmol/L) Target of rapamycin inhibitors (TOR‐I) vs calcineurin inhibitors (CNI): secondary outcomes | no estimate extracted | 8 studies · 843 participants | Low Downgraded: imprecision |
Thrombocytopenia Target of rapamycin inhibitors (TOR‐I) vs calcineurin inhibitors (CNI): secondary outcomes | RR 5.26 [2.87, 9.63] | 4 studies · 593 participants | Low Downgraded: imprecision |
Target of rapamycin inhibitors (TOR‐I) versus antimetabolites: primary outcomes for primary immunosuppression in kidney transplant recipients
Population: primary immunosuppression in kidney transplant recipients
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcomes (up to 2 years for primary outcomes) Target of rapamycin inhibitors (TOR‐I) vs antimetabolites: primary outcomes | no estimate extracted | NR | No studies |
Death (all causes) Target of rapamycin inhibitors (TOR‐I) vs antimetabolites: primary outcomes | RR 1.06 [0.84, 1.33] | 31 studies · 10482 participants | Moderate Downgraded: imprecision |
Graft loss (censored) Target of rapamycin inhibitors (TOR‐I) vs antimetabolites: primary outcomes | RR 1.09 [0.82, 1.45] | 26 studies · 8966 participants | Moderate Downgraded: imprecision |
Biopsy‐proven acute rejection Target of rapamycin inhibitors (TOR‐I) vs antimetabolites: primary outcomes | RR 0.95 [0.81, 1.12] | 24 studies · 10101 participants | Moderate Downgraded: imprecision, inconsistency |
CMV infection Target of rapamycin inhibitors (TOR‐I) vs antimetabolites: primary outcomes | RR 0.44 [0.34, 0.58] | 26 studies · 10049 participants | Moderate Downgraded: imprecision, inconsistency |
Adverse wound outcomes: all complications Target of rapamycin inhibitors (TOR‐I) vs antimetabolites: primary outcomes | RR 1.56 [1.28, 1.9] | 17 studies · 6913 participants | Moderate Downgraded: imprecision, inconsistency |
All malignancies Target of rapamycin inhibitors (TOR‐I) vs antimetabolites: primary outcomes | RR 0.83 [0.64, 1.07] | 17 studies · 8799 participants | Moderate Downgraded: imprecision |
Number needing to change treatment Target of rapamycin inhibitors (TOR‐I) vs antimetabolites: primary outcomes | RR 1.56 | 25 studies · 9747 participants | Moderate Downgraded: imprecision, inconsistency |
Target of rapamycin inhibitors (TOR‐I) versus antimetabolites: secondary outcomes for primary immunosuppression in kidney transplant recipients
Population: primary immunosuppression in kidney transplant recipients
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcomes (up to 2 years for secondary outcomes) Target of rapamycin inhibitors (TOR‐I) vs antimetabolites: secondary outcomes | no estimate extracted | NR | No studies |
New‐onset diabetes mellitus Target of rapamycin inhibitors (TOR‐I) vs antimetabolites: secondary outcomes | RR 1.28 [1.07, 1.54] | 23 studies · 8728 participants | Moderate Downgraded: publication bias |
BK virus infection Target of rapamycin inhibitors (TOR‐I) vs antimetabolites: secondary outcomes | RR 0.62 [0.5, 0.76] | 12 studies · 5152 participants | High |
GFR (mL/min) Target of rapamycin inhibitors (TOR‐I) vs antimetabolites: secondary outcomes | no estimate extracted | 25 studies · 7099 participants | Moderate Downgraded: imprecision, inconsistency, publication bias |
Hypercholesterolaemia Target of rapamycin inhibitors (TOR‐I) vs antimetabolites: secondary outcomes | RR 1.83 [1.48, 2.25] | 12 studies · 5725 participants | Low Downgraded: publication bias |
Hypertriglyceridaemia Target of rapamycin inhibitors (TOR‐I) vs antimetabolites: secondary outcomes | RR 1.48 [1.26, 1.74] | 9 studies · 4698 participants | Moderate Downgraded: publication bias |
Leucopenia Target of rapamycin inhibitors (TOR‐I) vs antimetabolites: secondary outcomes | RR 0.43 [0.33, 0.56] | 15 studies · 8396 participants | Low Downgraded: publication bias |
Thrombocytopenia Target of rapamycin inhibitors (TOR‐I) vs antimetabolites: secondary outcomes | RR 1.96 [1.38, 2.79] | 8 studies · 5028 participants | Low Downgraded: publication bias |
Variable target of rapamycin inhibitor (TOR‐I) and calcineurin inhibitor (CNI): primary outcomes for primary immunosuppression in kidney transplant recipients
Population: primary immunosuppression in kidney transplant recipients
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcomes (up to 2 years for primary outcomes) | no estimate extracted | NR | No studies |
Death (all causes) | RR 1.07 [0.64, 1.78] | 9 studies · 1501 participants | Moderate Downgraded: imprecision |
Graft loss (censored) | RR 1.09 [0.54, 2.2] | 8 studies · 1385 participants | Moderate Downgraded: imprecision |
Biopsy‐proven acute rejection | RR 0.87 [0.67, 1.13] | 8 studies · 1381 participants | Moderate Downgraded: imprecision |
CMV infection | RR 1.42 [0.78, 2.6] | 5 studies · 865 participants | Moderate Downgraded: imprecision, inconsistency |
Adverse wound outcomes: all complications | RR 0.95 [0.53, 1.71] | 3 studies · 291 participants | Low Downgraded: imprecision, inconsistency |
All malignancies | RR 1.04 [0.36, 3.04] | 7 studies · 1163 participants | Low Downgraded: imprecision |
Number needing to change treatment | RR 1.18 [0.58, 2.42] | 5 studies · 734 participants | Low Downgraded: imprecision, inconsistency |
Variable target of rapamycin inhibitor (TOR‐I) and calcineurin inhibitor (CNI): secondary outcomes for primary immunosuppression in kidney transplant recipients
Population: primary immunosuppression in kidney transplant recipients
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcomes (up to 2 years for secondary outcomes) | no estimate extracted | NR | No studies |
New‐onset diabetes mellitus: TAC | RR 1.79 [0.99, 3.23] | 5 studies · 580 participants | Low Downgraded: imprecision |
New‐onset diabetes mellitus: CSA | RR 0.57 [0.27, 1.2] | 3 studies · 606 participants | Low Downgraded: imprecision |
GFR (mL/min) | no estimate extracted | 7 studies · 1305 participants | Low Downgraded: imprecision |
Hypercholesterolaemia | RR 0.96 [0.75, 1.22] | 4 studies · 734 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Hypertriglyceridaemia | RR 0.85 [0.73, 1.01] | 4 studies · 734 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Anaemia | RR 0.93 [0.8, 1.08] | 6 studies · 1074 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Leucopenia | RR 0.99 [0.7, 1.4] | 5 studies · 1012 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Low versus higher dose target of rapamycin inhibitor (TOR‐I): primary outcomes for primary immunosuppression in kidney transplant recipients
Population: primary immunosuppression in kidney transplant recipients
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death (all causes) Low vs higher dose target of rapamycin inhibitor (TOR‐I): primary outcomes | RR 0.89 [0.63, 1.25] | 13 studies · 3894 participants | Moderate Downgraded: imprecision |
Total graft loss (with death) Low vs higher dose target of rapamycin inhibitor (TOR‐I): primary outcomes | RR 0.84 [0.67, 1.06] | 11 studies · 3476 participants | Moderate Downgraded: imprecision |
Biopsy‐proven acute rejection Low vs higher dose target of rapamycin inhibitor (TOR‐I): primary outcomes | RR 1.26 [1.1, 1.43] | 11 studies · 3731 participants | Moderate Downgraded: imprecision |
CMV infection Low vs higher dose target of rapamycin inhibitor (TOR‐I): primary outcomes | RR 0.87 [0.63, 1.21] | 9 studies · 3099 participants | Moderate Downgraded: imprecision, inconsistency |
All malignancy Low vs higher dose target of rapamycin inhibitor (TOR‐I): primary outcomes | RR 0.84 [0.54, 1.32] | 10 studies · 3175 participants | Moderate Downgraded: imprecision |
Number needing to change treatment Low vs higher dose target of rapamycin inhibitor (TOR‐I): primary outcomes | RR 0.91 [0.78, 1.05] | 10 studies · 3652 participants | Low Downgraded: imprecision |
Low versus higher dose target of rapamycin inhibitor (TOR‐ I): secondary outcomes for primary immunosuppression in kidney transplant recipients
Population: primary immunosuppression in kidney transplant recipients
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Diabetes Low vs higher dose target of rapamycin inhibitor (TOR‐ I): secondary outcomes | RR 0.69 [0.51, 0.93] | 6 studies · 2125 participants | Moderate Downgraded: imprecision |
Lymphoma/PTLD Low vs higher dose target of rapamycin inhibitor (TOR‐ I): secondary outcomes | RR 0.66 [0.25, 1.73] | 7 studies · 2792 participants | Moderate Downgraded: imprecision |
Acne/rash Low vs higher dose target of rapamycin inhibitor (TOR‐ I): secondary outcomes | RR 0.86 [0.62, 1.21] | 6 studies · 2958 participants | Low Downgraded: imprecision |
GRF (mL/min) Low vs higher dose target of rapamycin inhibitor (TOR‐ I): secondary outcomes | no estimate extracted | 7 studies · 1863 participants | Low Downgraded: imprecision |
Hypercholesterolaemia Low vs higher dose target of rapamycin inhibitor (TOR‐ I): secondary outcomes | RR 0.87 [0.78, 0.98] | 9 studies · 3250 participants | Moderate Downgraded: imprecision |
Anaemia Low vs higher dose target of rapamycin inhibitor (TOR‐ I): secondary outcomes | RR 0.81 [0.72, 0.91] | 10 studies · 3179 participants | Low Downgraded: imprecision |
Thrombocytopenia Low vs higher dose target of rapamycin inhibitor (TOR‐ I): secondary outcomes | RR 0.58 [0.44, 0.75] | 9 studies · 2242 participants | Low Downgraded: imprecision |