Cochrane · systematic review · CD006750
Calcineurin inhibitor withdrawal or tapering for kidney transplant recipients
Karpe, KM, Talaulikar, GS, Walters, GD · Cochrane Database of Systematic Reviews · 2017 · 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
40
current version
GRADE rated
40
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 0 · 0%Very low 1 · 2.5%Low 19 · 47.5%Moderate 20 · 50%High 0 · 0%
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
Calcineurin inhibitor (CNI) withdrawal versus standard dose CNI for kidney transplant recipients
Population: kidney transplant recipients
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death Calcineurin inhibitor (CNI) withdrawal vs standard dose CNI | RR 1.09 [0.96, 1.24] | 2010 participants | Moderate Downgraded: inconsistency |
Acute rejection Calcineurin inhibitor (CNI) withdrawal vs standard dose CNI | RR 2.54 [1.56, 4.12] | 15 studies · 1666 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, publication bias |
GFR Calcineurin inhibitor (CNI) withdrawal vs standard dose CNI | no estimate extracted | 8 studies · 910 participants | Low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Graft loss Calcineurin inhibitor (CNI) withdrawal vs standard dose CNI | RR 0.85 [0.74, 0.98] | 16 studies · 2090 participants | Low Downgraded: inconsistency |
Adverse events: hypertension Calcineurin inhibitor (CNI) withdrawal vs standard dose CNI | RR 0.82 [0.71, 0.95] | 950 participants | Low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Adverse events: CMV infection Calcineurin inhibitor (CNI) withdrawal vs standard dose CNI | RR 0.87 [0.52, 1.45] | 7 studies · 608 participants | Low Downgraded: inconsistency |
Adverse events: malignancy Calcineurin inhibitor (CNI) withdrawal vs standard dose CNI | RR 1.1 [0.93, 1.3] | 6 studies · 1079 participants | Low Downgraded: inconsistency |
Low dose calcineurin inhibitors (CNI) versus to standard dose CNI for kidney transplant recipients
Population: kidney transplant recipients
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death Low dose calcineurin inhibitors (CNI) vs to standard dose CNI | RR 0.79 [0.5, 1.27] | 15 studies · 3462 participants | Moderate Downgraded: risk of bias |
Acute rejection Low dose calcineurin inhibitors (CNI) vs to standard dose CNI | RR 0.87 [0.76, 1] | 19 studies · 3757 participants | Moderate Downgraded: risk of bias |
GFR Low dose calcineurin inhibitors (CNI) vs to standard dose CNI | no estimate extracted | 13 studies · 2623 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Graft loss Low dose calcineurin inhibitors (CNI) vs to standard dose CNI | RR 0.75 [0.55, 1.02] | 15 studies · 3286 participants | Moderate Downgraded: risk of bias |
Adverse events: hypertension Low dose calcineurin inhibitors (CNI) vs to standard dose CNI | RR 0.84 [0.7, 1] | 5 studies · 1877 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Adverse events: CMV infection Low dose calcineurin inhibitors (CNI) vs to standard dose CNI | RR 1.23 [0.94, 1.62] | 6 studies · 1948 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Adverse events: malignancy Low dose calcineurin inhibitors (CNI) vs to standard dose CNI | RR 0.9 [0.41, 1.97] | 5 studies · 1637 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Calcineurin inhibitor (CNI) withdrawal + mammalian target of rapamycin inhibitor (mTORi) versus standard dose CNI for kidney transplant recipients
Population: kidney transplant recipients
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death Calcineurin inhibitor (CNI) withdrawal + mammalian target of rapamycin inhibitor (mTORi) vs standard dose CNI | RR 0.99 [0.69, 1.4] | 23 studies · 5427 participants | Moderate Downgraded: risk of bias |
Acute rejection Calcineurin inhibitor (CNI) withdrawal + mammalian target of rapamycin inhibitor (mTORi) vs standard dose CNI | RR 1.43 [1.15, 1.78] | 30 studies · 5903 participants | Moderate Downgraded: risk of bias |
Graft loss Calcineurin inhibitor (CNI) withdrawal + mammalian target of rapamycin inhibitor (mTORi) vs standard dose CNI | RR 0.94 [0.75, 1.19] | 25 studies · 5446 participants | Low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Adverse events: hypertension Calcineurin inhibitor (CNI) withdrawal + mammalian target of rapamycin inhibitor (mTORi) vs standard dose CNI | RR 0.86 [0.64, 1.15] | 7 studies · 2207 participants | Low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Adverse events: CMV Infection Calcineurin inhibitor (CNI) withdrawal + mammalian target of rapamycin inhibitor (mTORi) vs standard dose CNI | RR 0.6 [0.44, 0.82] | 13 studies · 2503 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Adverse events: malignancy Calcineurin inhibitor (CNI) withdrawal + mammalian target of rapamycin inhibitor (mTORi) vs standard dose CNI | RR 0.69 [0.47, 1] | 14 studies · 3699 participants | Low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Adverse events: lymphocele Calcineurin inhibitor (CNI) withdrawal + mammalian target of rapamycin inhibitor (mTORi) vs standard dose CNI | RR 1.45 [0.95, 2.21] | 8 studies · 1926 participants | Low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Low dose CNI calcineurin inhibitor (CNI) + mammalian target of rapamycin inhibitor (mTORi) versus standard dose CNI for kidney transplant recipients
Population: kidney transplant recipients
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death Low dose CNI calcineurin inhibitor (CNI) + mammalian target of rapamycin inhibitor (mTORi) vs standard dose CNI | RR 1.16 [0.71, 1.9] | 11 studies · 2750 participants | Moderate Downgraded: risk of bias |
Acute rejection Low dose CNI calcineurin inhibitor (CNI) + mammalian target of rapamycin inhibitor (mTORi) vs standard dose CNI | RR 1.13 [0.91, 1.4] | 16 studies · 3300 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
GFR Low dose CNI calcineurin inhibitor (CNI) + mammalian target of rapamycin inhibitor (mTORi) vs standard dose CNI | no estimate extracted | 11 studies · 1749 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Graft loss Low dose CNI calcineurin inhibitor (CNI) + mammalian target of rapamycin inhibitor (mTORi) vs standard dose CNI | RR 0.67 [0.45, 1.01] | 16 studies · 3304 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Adverse events: hypertension Low dose CNI calcineurin inhibitor (CNI) + mammalian target of rapamycin inhibitor (mTORi) vs standard dose CNI | RR 0.98 [0.8, 1.2] | 5 studies · 1421 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Adverse events: CMV infection Low dose CNI calcineurin inhibitor (CNI) + mammalian target of rapamycin inhibitor (mTORi) vs standard dose CNI | RR 0.41 [0.16, 1.06] | 5 studies · 1250 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Adverse events: malignancy Low dose CNI calcineurin inhibitor (CNI) + mammalian target of rapamycin inhibitor (mTORi) vs standard dose CNI | RR 1.22 [0.42, 3.52] | 5 studies · 1074 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Calcineurin inhibitor (CNI) avoidance and late CNI withdrawal versus standard dose CNI
Population: kidney transplant recipients
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Acute rejection: avoidance Calcineurin inhibitor (CNI) avoidance and late CNI withdrawal vs standard dose CNI | RR 2.16 [0.85, 5.49] | 3 studies · 238 participants | Low Downgraded: imprecision |
Acute rejection: late withdrawal Calcineurin inhibitor (CNI) avoidance and late CNI withdrawal vs standard dose CNI | RR 3.21 [1.59, 6.48] | 12 studies · 1428 participants | Moderate Downgraded: imprecision, inconsistency, publication bias |
GFR: avoidance Calcineurin inhibitor (CNI) avoidance and late CNI withdrawal vs standard dose CNI | no estimate extracted | 3 studies · 242 participants | Very low Downgraded: imprecision |
GFR: late withdrawal Calcineurin inhibitor (CNI) avoidance and late CNI withdrawal vs standard dose CNI | no estimate extracted | 5 studies · 668 participants | Low Downgraded: imprecision, inconsistency, publication bias |
Graft loss: avoidance Calcineurin inhibitor (CNI) avoidance and late CNI withdrawal vs standard dose CNI | RR 0.96 [0.79, 1.16] | 4 studies · 566 participants | Low Downgraded: imprecision, inconsistency, publication bias |
Graft loss: late withdrawal Calcineurin inhibitor (CNI) avoidance and late CNI withdrawal vs standard dose CNI | RR 0.84 [0.72, 0.97] | 13 studies · 1831 participants | Moderate Downgraded: imprecision, inconsistency, publication bias |
Calcineurin inhibitor (CNI) avoidance and late withdrawal with mammalian target of rapamycin inhibitor (mTORi) versus standard dose CNI
Population: kidney transplant recipients
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Acute rejection: avoidance Calcineurin inhibitor (CNI) avoidance and late withdrawal with mammalian target of rapamycin inhibitor (mTORi) vs standard dose CNI | RR 1.27 [0.98, 1.65] | 11 studies · 1844 participants | Moderate Downgraded: imprecision |
Acute rejection: late withdrawal Calcineurin inhibitor (CNI) avoidance and late withdrawal with mammalian target of rapamycin inhibitor (mTORi) vs standard dose CNI | RR 1.9 [1.44, 2.51] | 17 studies · 3636 participants | Moderate Downgraded: imprecision |
GFR: avoidance Calcineurin inhibitor (CNI) avoidance and late withdrawal with mammalian target of rapamycin inhibitor (mTORi) vs standard dose CNI | no estimate extracted | 9 studies · 1748 participants | Low Downgraded: imprecision |
GFR: late withdrawal Calcineurin inhibitor (CNI) avoidance and late withdrawal with mammalian target of rapamycin inhibitor (mTORi) vs standard dose CNI | no estimate extracted | 14 studies · 2679 participants | Low Downgraded: imprecision |
Graft loss: avoidance Calcineurin inhibitor (CNI) avoidance and late withdrawal with mammalian target of rapamycin inhibitor (mTORi) vs standard dose CNI | RR 1.03 [0.72, 1.48] | 8 studies · 1420 participants | Moderate Downgraded: imprecision |
Graft loss: late withdrawal Calcineurin inhibitor (CNI) avoidance and late withdrawal with mammalian target of rapamycin inhibitor (mTORi) vs standard dose CNI | RR 0.92 [0.65, 1.3] | 17 studies · 4026 participants | Moderate Downgraded: imprecision |