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Cochrane Database of Systematic Reviews

Inducción de anticuerpos inmunosupresores contra linfocitos T para los receptores de trasplante de corazón

Information

DOI:
https://doi.org/10.1002/14651858.CD008842.pub2Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 02 December 2013see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:
  1. Cochrane Heart Group

Copyright:
  1. Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • Luit Penninga

    Correspondence to: Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

    [email protected]

    [email protected]

  • Christian H Møller

    Department of Cardiothoracic Surgery, RT 2152, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

  • Finn Gustafsson

    Department of Cardiology B, Copenhagen University Hospital, Copenhagen, Denmark

  • Christian Gluud

    The Cochrane Hepato‐Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

  • Daniel A Steinbrüchel

    Department of Cardiothoracic Surgery, RT 2152, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

Contributions of authors

  1. Drafting the protocol: LP, CM, FG. DS, CG.

  2. Study selection: LP, CM.

  3. Extraction of data from studies: LP, CM, FG.

  4. Data‐entry in RevMan: LP, CM.

  5. Performing the analysis: LP, CM, CG.

  6. Interpretation of the analysis: LP, CM, FG, CG.

  7. Drafting the review: LP

  8. Resolution of disagreements: CG.

  9. Critical editing of the review: LP, CM, FG, CG, DS.

Sources of support

Internal sources

  • Rigshospitalet Research Council, Copenhagen, Denmark.

    Grant to LP

External sources

  • No sources of support supplied

Declarations of interest

Luit Penninga: none known
Christian H Møller: none known
Finn Gustafsson: none known
Christian Gluud: none known
Daniel A Steinbrüchel: none known

Acknowledgements

We would like to thank

  1. the Cochrane Heart Group for their support in preparing this review,

  2. the referees for their comments and feedback during the preparation of the protocol and review.

  3. the investigators and participants of the included RCTs ‐ without their initiative we would have nothing to review.

Version history

Published

Title

Stage

Authors

Version

2013 Dec 02

Immunosuppressive T‐cell antibody induction for heart transplant recipients

Review

Luit Penninga, Christian H Møller, Finn Gustafsson, Christian Gluud, Daniel A Steinbrüchel

https://doi.org/10.1002/14651858.CD008842.pub2

2010 Nov 10

Immunosuppressive T‐cell antibody induction therapy for heart transplant recipients

Protocol

Luit Penninga, Christian H Møller, Finn Gustafsson, Christian Gluud, Daniel A Steinbrüchel

https://doi.org/10.1002/14651858.CD008842

Differences between protocol and review

At the Cochrane Colloquium, October 2010, Keystone, Colorado, USA, agreement was reached that 'baseline imbalance' and 'early stopping' in an individual trial may cause bias in that trial, but not necessarily in the meta‐analysis. We have therefore removed 'baseline imbalance' and 'early stopping' as criteria of bias.

Keywords

MeSH

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Study flow diagram
Figures and Tables -
Figure 1

Study flow diagram

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
Figures and Tables -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies

Risk of bias summary: review authors' judgements about each risk of bias item for each included study
Figures and Tables -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study

Interleukin‐2 receptor antagonist induction versus no induction: mortality: trial sequential analysis of the effect of interleukin‐2 receptor antagonist induction versus no induction on mortality based on four trials with 576 participants. The diversity adjusted required information size (DARIS) of 11138 participants was calculated based on type I error of 5%, type II error of 20%, risk reduction of 20%, and information size was adjusted for diversity (0%). The cumulative Z‐curve does not cross trial sequential alpha and beta spending monitoring boundaries, and required information size was not reached.
Figures and Tables -
Figure 4

Interleukin‐2 receptor antagonist induction versus no induction: mortality: trial sequential analysis of the effect of interleukin‐2 receptor antagonist induction versus no induction on mortality based on four trials with 576 participants. The diversity adjusted required information size (DARIS) of 11138 participants was calculated based on type I error of 5%, type II error of 20%, risk reduction of 20%, and information size was adjusted for diversity (0%). The cumulative Z‐curve does not cross trial sequential alpha and beta spending monitoring boundaries, and required information size was not reached.

Interleukin‐2 receptor antagonist induction versus no induction: acute rejection: trial sequential analysis of the effect of interleukin‐2 receptor antagonist induction versus no induction on acute rejection based on four trials with 576 participants. The diversity adjusted required information size (DARIS) of 4707 participants was calculated based on type I error of 5%, type II error of 20%, risk reduction of 20%, and information size was adjusted for diversity (80%). The cumulative Z‐curve does not cross trial sequential alpha and beta spending monitoring boundaries, and required information size was not reached.
Figures and Tables -
Figure 5

Interleukin‐2 receptor antagonist induction versus no induction: acute rejection: trial sequential analysis of the effect of interleukin‐2 receptor antagonist induction versus no induction on acute rejection based on four trials with 576 participants. The diversity adjusted required information size (DARIS) of 4707 participants was calculated based on type I error of 5%, type II error of 20%, risk reduction of 20%, and information size was adjusted for diversity (80%). The cumulative Z‐curve does not cross trial sequential alpha and beta spending monitoring boundaries, and required information size was not reached.

Interleukin‐2 receptor antagonist induction versus no induction: infection: trial sequential analysis of the effect of interleukin‐2 receptor antagonist induction versus no induction on infection based on three trials with 545 participants. The diversity adjusted required information size (DARIS) of 1255 participants was calculated based on type I error of 5%, type II error of 20%, risk reduction of 20%, and information size was adjusted for diversity (6%). The cumulative Z‐curve does not cross trial sequential alpha spending monitoring boundary, and required information size was not reached. However, the cumulative Z‐curve reaches the area of futility (trial sequential beta spending monitoring boundary), hence we can reject a difference of 20% of more between the groups regarding infection.
Figures and Tables -
Figure 6

Interleukin‐2 receptor antagonist induction versus no induction: infection: trial sequential analysis of the effect of interleukin‐2 receptor antagonist induction versus no induction on infection based on three trials with 545 participants. The diversity adjusted required information size (DARIS) of 1255 participants was calculated based on type I error of 5%, type II error of 20%, risk reduction of 20%, and information size was adjusted for diversity (6%). The cumulative Z‐curve does not cross trial sequential alpha spending monitoring boundary, and required information size was not reached. However, the cumulative Z‐curve reaches the area of futility (trial sequential beta spending monitoring boundary), hence we can reject a difference of 20% of more between the groups regarding infection.

Comparison 1 Antibody induction versus no induction, Outcome 1 Mortality.
Figures and Tables -
Analysis 1.1

Comparison 1 Antibody induction versus no induction, Outcome 1 Mortality.

Comparison 1 Antibody induction versus no induction, Outcome 2 Acute rejection.
Figures and Tables -
Analysis 1.2

Comparison 1 Antibody induction versus no induction, Outcome 2 Acute rejection.

Comparison 1 Antibody induction versus no induction, Outcome 3 Infection.
Figures and Tables -
Analysis 1.3

Comparison 1 Antibody induction versus no induction, Outcome 3 Infection.

Comparison 1 Antibody induction versus no induction, Outcome 4 Cytomegalovirus infection.
Figures and Tables -
Analysis 1.4

Comparison 1 Antibody induction versus no induction, Outcome 4 Cytomegalovirus infection.

Comparison 1 Antibody induction versus no induction, Outcome 5 Post‐transplantation lymphoproliferative disorder.
Figures and Tables -
Analysis 1.5

Comparison 1 Antibody induction versus no induction, Outcome 5 Post‐transplantation lymphoproliferative disorder.

Comparison 1 Antibody induction versus no induction, Outcome 6 Cancer.
Figures and Tables -
Analysis 1.6

Comparison 1 Antibody induction versus no induction, Outcome 6 Cancer.

Comparison 1 Antibody induction versus no induction, Outcome 7 Adverse events.
Figures and Tables -
Analysis 1.7

Comparison 1 Antibody induction versus no induction, Outcome 7 Adverse events.

Comparison 1 Antibody induction versus no induction, Outcome 8 Chronic allograft vasculopathy.
Figures and Tables -
Analysis 1.8

Comparison 1 Antibody induction versus no induction, Outcome 8 Chronic allograft vasculopathy.

Comparison 1 Antibody induction versus no induction, Outcome 9 Renal failure requiring chronic dialysis.
Figures and Tables -
Analysis 1.9

Comparison 1 Antibody induction versus no induction, Outcome 9 Renal failure requiring chronic dialysis.

Comparison 1 Antibody induction versus no induction, Outcome 10 Serum creatinine.
Figures and Tables -
Analysis 1.10

Comparison 1 Antibody induction versus no induction, Outcome 10 Serum creatinine.

Comparison 1 Antibody induction versus no induction, Outcome 11 Hypertension.
Figures and Tables -
Analysis 1.11

Comparison 1 Antibody induction versus no induction, Outcome 11 Hypertension.

Comparison 2 Interleukin‐2 receptor antagonist (IL‐2 RA) versus no induction, Outcome 1 Mortality.
Figures and Tables -
Analysis 2.1

Comparison 2 Interleukin‐2 receptor antagonist (IL‐2 RA) versus no induction, Outcome 1 Mortality.

Comparison 2 Interleukin‐2 receptor antagonist (IL‐2 RA) versus no induction, Outcome 2 Acute rejection.
Figures and Tables -
Analysis 2.2

Comparison 2 Interleukin‐2 receptor antagonist (IL‐2 RA) versus no induction, Outcome 2 Acute rejection.

Comparison 2 Interleukin‐2 receptor antagonist (IL‐2 RA) versus no induction, Outcome 3 Infection.
Figures and Tables -
Analysis 2.3

Comparison 2 Interleukin‐2 receptor antagonist (IL‐2 RA) versus no induction, Outcome 3 Infection.

Comparison 2 Interleukin‐2 receptor antagonist (IL‐2 RA) versus no induction, Outcome 4 Cytomegalovirus infection.
Figures and Tables -
Analysis 2.4

Comparison 2 Interleukin‐2 receptor antagonist (IL‐2 RA) versus no induction, Outcome 4 Cytomegalovirus infection.

Comparison 2 Interleukin‐2 receptor antagonist (IL‐2 RA) versus no induction, Outcome 5 Post‐transplantation lymphoproliferative disorder.
Figures and Tables -
Analysis 2.5

Comparison 2 Interleukin‐2 receptor antagonist (IL‐2 RA) versus no induction, Outcome 5 Post‐transplantation lymphoproliferative disorder.

Comparison 2 Interleukin‐2 receptor antagonist (IL‐2 RA) versus no induction, Outcome 6 Cancer.
Figures and Tables -
Analysis 2.6

Comparison 2 Interleukin‐2 receptor antagonist (IL‐2 RA) versus no induction, Outcome 6 Cancer.

Comparison 2 Interleukin‐2 receptor antagonist (IL‐2 RA) versus no induction, Outcome 7 Adverse events.
Figures and Tables -
Analysis 2.7

Comparison 2 Interleukin‐2 receptor antagonist (IL‐2 RA) versus no induction, Outcome 7 Adverse events.

Comparison 2 Interleukin‐2 receptor antagonist (IL‐2 RA) versus no induction, Outcome 8 Hypertension.
Figures and Tables -
Analysis 2.8

Comparison 2 Interleukin‐2 receptor antagonist (IL‐2 RA) versus no induction, Outcome 8 Hypertension.

Comparison 3 Interleukin‐2 receptor antagonist (IL‐2 RA) versus monoclonal antibody, Outcome 1 Mortality.
Figures and Tables -
Analysis 3.1

Comparison 3 Interleukin‐2 receptor antagonist (IL‐2 RA) versus monoclonal antibody, Outcome 1 Mortality.

Comparison 3 Interleukin‐2 receptor antagonist (IL‐2 RA) versus monoclonal antibody, Outcome 2 Acute rejection.
Figures and Tables -
Analysis 3.2

Comparison 3 Interleukin‐2 receptor antagonist (IL‐2 RA) versus monoclonal antibody, Outcome 2 Acute rejection.

Comparison 3 Interleukin‐2 receptor antagonist (IL‐2 RA) versus monoclonal antibody, Outcome 3 Infection.
Figures and Tables -
Analysis 3.3

Comparison 3 Interleukin‐2 receptor antagonist (IL‐2 RA) versus monoclonal antibody, Outcome 3 Infection.

Comparison 3 Interleukin‐2 receptor antagonist (IL‐2 RA) versus monoclonal antibody, Outcome 4 Cytomegalovirus infection.
Figures and Tables -
Analysis 3.4

Comparison 3 Interleukin‐2 receptor antagonist (IL‐2 RA) versus monoclonal antibody, Outcome 4 Cytomegalovirus infection.

Comparison 3 Interleukin‐2 receptor antagonist (IL‐2 RA) versus monoclonal antibody, Outcome 5 Post‐transplantation lymphoproliferative disorder.
Figures and Tables -
Analysis 3.5

Comparison 3 Interleukin‐2 receptor antagonist (IL‐2 RA) versus monoclonal antibody, Outcome 5 Post‐transplantation lymphoproliferative disorder.

Comparison 3 Interleukin‐2 receptor antagonist (IL‐2 RA) versus monoclonal antibody, Outcome 6 Cancer.
Figures and Tables -
Analysis 3.6

Comparison 3 Interleukin‐2 receptor antagonist (IL‐2 RA) versus monoclonal antibody, Outcome 6 Cancer.

Comparison 3 Interleukin‐2 receptor antagonist (IL‐2 RA) versus monoclonal antibody, Outcome 7 Adverse events.
Figures and Tables -
Analysis 3.7

Comparison 3 Interleukin‐2 receptor antagonist (IL‐2 RA) versus monoclonal antibody, Outcome 7 Adverse events.

Comparison 4 Interleukin‐2 receptor antagonist (IL‐2 RA) versus polyclonal antibody, Outcome 1 Mortality.
Figures and Tables -
Analysis 4.1

Comparison 4 Interleukin‐2 receptor antagonist (IL‐2 RA) versus polyclonal antibody, Outcome 1 Mortality.

Comparison 4 Interleukin‐2 receptor antagonist (IL‐2 RA) versus polyclonal antibody, Outcome 2 Acute rejection.
Figures and Tables -
Analysis 4.2

Comparison 4 Interleukin‐2 receptor antagonist (IL‐2 RA) versus polyclonal antibody, Outcome 2 Acute rejection.

Comparison 4 Interleukin‐2 receptor antagonist (IL‐2 RA) versus polyclonal antibody, Outcome 3 Infection.
Figures and Tables -
Analysis 4.3

Comparison 4 Interleukin‐2 receptor antagonist (IL‐2 RA) versus polyclonal antibody, Outcome 3 Infection.

Comparison 4 Interleukin‐2 receptor antagonist (IL‐2 RA) versus polyclonal antibody, Outcome 4 Cytomegalovirus infection.
Figures and Tables -
Analysis 4.4

Comparison 4 Interleukin‐2 receptor antagonist (IL‐2 RA) versus polyclonal antibody, Outcome 4 Cytomegalovirus infection.

Comparison 4 Interleukin‐2 receptor antagonist (IL‐2 RA) versus polyclonal antibody, Outcome 5 Post‐transplantation lymphoproliferative disorder.
Figures and Tables -
Analysis 4.5

Comparison 4 Interleukin‐2 receptor antagonist (IL‐2 RA) versus polyclonal antibody, Outcome 5 Post‐transplantation lymphoproliferative disorder.

Comparison 4 Interleukin‐2 receptor antagonist (IL‐2 RA) versus polyclonal antibody, Outcome 6 Cancer.
Figures and Tables -
Analysis 4.6

Comparison 4 Interleukin‐2 receptor antagonist (IL‐2 RA) versus polyclonal antibody, Outcome 6 Cancer.

Comparison 4 Interleukin‐2 receptor antagonist (IL‐2 RA) versus polyclonal antibody, Outcome 7 Adverse events.
Figures and Tables -
Analysis 4.7

Comparison 4 Interleukin‐2 receptor antagonist (IL‐2 RA) versus polyclonal antibody, Outcome 7 Adverse events.

Comparison 4 Interleukin‐2 receptor antagonist (IL‐2 RA) versus polyclonal antibody, Outcome 8 Chronic allograft vasculopathy.
Figures and Tables -
Analysis 4.8

Comparison 4 Interleukin‐2 receptor antagonist (IL‐2 RA) versus polyclonal antibody, Outcome 8 Chronic allograft vasculopathy.

Comparison 5 Monoclonal antibody versus polyclonal antibody, Outcome 1 Mortality.
Figures and Tables -
Analysis 5.1

Comparison 5 Monoclonal antibody versus polyclonal antibody, Outcome 1 Mortality.

Comparison 5 Monoclonal antibody versus polyclonal antibody, Outcome 2 Acute rejection.
Figures and Tables -
Analysis 5.2

Comparison 5 Monoclonal antibody versus polyclonal antibody, Outcome 2 Acute rejection.

Comparison 5 Monoclonal antibody versus polyclonal antibody, Outcome 3 Infection.
Figures and Tables -
Analysis 5.3

Comparison 5 Monoclonal antibody versus polyclonal antibody, Outcome 3 Infection.

Comparison 5 Monoclonal antibody versus polyclonal antibody, Outcome 4 Cytomegalovirus infection.
Figures and Tables -
Analysis 5.4

Comparison 5 Monoclonal antibody versus polyclonal antibody, Outcome 4 Cytomegalovirus infection.

Comparison 5 Monoclonal antibody versus polyclonal antibody, Outcome 5 Post‐transplantation lymphoproliferative disorder.
Figures and Tables -
Analysis 5.5

Comparison 5 Monoclonal antibody versus polyclonal antibody, Outcome 5 Post‐transplantation lymphoproliferative disorder.

Comparison 5 Monoclonal antibody versus polyclonal antibody, Outcome 6 Cancer.
Figures and Tables -
Analysis 5.6

Comparison 5 Monoclonal antibody versus polyclonal antibody, Outcome 6 Cancer.

Comparison 5 Monoclonal antibody versus polyclonal antibody, Outcome 7 Adverse events.
Figures and Tables -
Analysis 5.7

Comparison 5 Monoclonal antibody versus polyclonal antibody, Outcome 7 Adverse events.

Comparison 5 Monoclonal antibody versus polyclonal antibody, Outcome 8 Serum creatinine.
Figures and Tables -
Analysis 5.8

Comparison 5 Monoclonal antibody versus polyclonal antibody, Outcome 8 Serum creatinine.

Comparison 6 Anti‐thymocyte globulin (ATG) versus anti‐lymphocyte globulin (ALG), Outcome 1 Mortality.
Figures and Tables -
Analysis 6.1

Comparison 6 Anti‐thymocyte globulin (ATG) versus anti‐lymphocyte globulin (ALG), Outcome 1 Mortality.

Comparison 6 Anti‐thymocyte globulin (ATG) versus anti‐lymphocyte globulin (ALG), Outcome 2 Infection.
Figures and Tables -
Analysis 6.2

Comparison 6 Anti‐thymocyte globulin (ATG) versus anti‐lymphocyte globulin (ALG), Outcome 2 Infection.

Comparison 6 Anti‐thymocyte globulin (ATG) versus anti‐lymphocyte globulin (ALG), Outcome 3 Adverse events.
Figures and Tables -
Analysis 6.3

Comparison 6 Anti‐thymocyte globulin (ATG) versus anti‐lymphocyte globulin (ALG), Outcome 3 Adverse events.

Comparison 7 High‐dose anti‐thymocyte globulin (ATG) versus standard‐dose, Outcome 2 Acute rejection.
Figures and Tables -
Analysis 7.2

Comparison 7 High‐dose anti‐thymocyte globulin (ATG) versus standard‐dose, Outcome 2 Acute rejection.

Comparison 7 High‐dose anti‐thymocyte globulin (ATG) versus standard‐dose, Outcome 3 Infection.
Figures and Tables -
Analysis 7.3

Comparison 7 High‐dose anti‐thymocyte globulin (ATG) versus standard‐dose, Outcome 3 Infection.

Comparison 7 High‐dose anti‐thymocyte globulin (ATG) versus standard‐dose, Outcome 4 Cytomegalovirus infection.
Figures and Tables -
Analysis 7.4

Comparison 7 High‐dose anti‐thymocyte globulin (ATG) versus standard‐dose, Outcome 4 Cytomegalovirus infection.

Comparison 7 High‐dose anti‐thymocyte globulin (ATG) versus standard‐dose, Outcome 5 Post‐transplantation lymphoproliferative disorder.
Figures and Tables -
Analysis 7.5

Comparison 7 High‐dose anti‐thymocyte globulin (ATG) versus standard‐dose, Outcome 5 Post‐transplantation lymphoproliferative disorder.

Comparison 7 High‐dose anti‐thymocyte globulin (ATG) versus standard‐dose, Outcome 6 Cancer.
Figures and Tables -
Analysis 7.6

Comparison 7 High‐dose anti‐thymocyte globulin (ATG) versus standard‐dose, Outcome 6 Cancer.

Comparison 7 High‐dose anti‐thymocyte globulin (ATG) versus standard‐dose, Outcome 7 Adverse events.
Figures and Tables -
Analysis 7.7

Comparison 7 High‐dose anti‐thymocyte globulin (ATG) versus standard‐dose, Outcome 7 Adverse events.

Comparison 7 High‐dose anti‐thymocyte globulin (ATG) versus standard‐dose, Outcome 8 Chronic allograft vasculopathy.
Figures and Tables -
Analysis 7.8

Comparison 7 High‐dose anti‐thymocyte globulin (ATG) versus standard‐dose, Outcome 8 Chronic allograft vasculopathy.

Comparison 7 High‐dose anti‐thymocyte globulin (ATG) versus standard‐dose, Outcome 9 Renal failure requiring chronic dialysis.
Figures and Tables -
Analysis 7.9

Comparison 7 High‐dose anti‐thymocyte globulin (ATG) versus standard‐dose, Outcome 9 Renal failure requiring chronic dialysis.

Comparison 7 High‐dose anti‐thymocyte globulin (ATG) versus standard‐dose, Outcome 10 Mortality.
Figures and Tables -
Analysis 7.10

Comparison 7 High‐dose anti‐thymocyte globulin (ATG) versus standard‐dose, Outcome 10 Mortality.

Comparison 8 RATG‐Thymoglobulin versus RATG‐Fresenius, Outcome 1 Mortality.
Figures and Tables -
Analysis 8.1

Comparison 8 RATG‐Thymoglobulin versus RATG‐Fresenius, Outcome 1 Mortality.

Comparison 8 RATG‐Thymoglobulin versus RATG‐Fresenius, Outcome 2 Acute rejection.
Figures and Tables -
Analysis 8.2

Comparison 8 RATG‐Thymoglobulin versus RATG‐Fresenius, Outcome 2 Acute rejection.

Comparison 8 RATG‐Thymoglobulin versus RATG‐Fresenius, Outcome 3 Infection.
Figures and Tables -
Analysis 8.3

Comparison 8 RATG‐Thymoglobulin versus RATG‐Fresenius, Outcome 3 Infection.

Comparison 8 RATG‐Thymoglobulin versus RATG‐Fresenius, Outcome 4 Cytomegalovirus infection.
Figures and Tables -
Analysis 8.4

Comparison 8 RATG‐Thymoglobulin versus RATG‐Fresenius, Outcome 4 Cytomegalovirus infection.

Comparison 8 RATG‐Thymoglobulin versus RATG‐Fresenius, Outcome 5 Post‐transplantation lymphoproliferative disorder.
Figures and Tables -
Analysis 8.5

Comparison 8 RATG‐Thymoglobulin versus RATG‐Fresenius, Outcome 5 Post‐transplantation lymphoproliferative disorder.

Comparison 8 RATG‐Thymoglobulin versus RATG‐Fresenius, Outcome 6 Cancer.
Figures and Tables -
Analysis 8.6

Comparison 8 RATG‐Thymoglobulin versus RATG‐Fresenius, Outcome 6 Cancer.

Comparison 8 RATG‐Thymoglobulin versus RATG‐Fresenius, Outcome 7 Adverse events.
Figures and Tables -
Analysis 8.7

Comparison 8 RATG‐Thymoglobulin versus RATG‐Fresenius, Outcome 7 Adverse events.

Comparison 8 RATG‐Thymoglobulin versus RATG‐Fresenius, Outcome 8 Chronic allograft vasculopathy.
Figures and Tables -
Analysis 8.8

Comparison 8 RATG‐Thymoglobulin versus RATG‐Fresenius, Outcome 8 Chronic allograft vasculopathy.

Summary of findings for the main comparison. Antibody induction for heart transplant recipients

Antibody induction for heart transplant recipients

Patient or population: heart transplant recipients
Settings: hospital
Intervention: antibody induction
Comparison: no induction

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)1

Comments

Assumed risk

Corresponding risk

No induction

Antibody induction

Mortality
Mortality at latest follow‐up
Follow‐up: 6‐12 months

Study population

RR 1.53
(0.85 to 2.76)

606
(5 studies)

⊕⊕⊝⊝
low

59 per 1000

90 per 1000
(50 to 162)

Moderate

55 per 1000

84 per 1000
(47 to 152)

Acute rejection
Acute rejection grade 3A or more verified by biopsy

Follow‐up: 12 months

Study population

RR 0.73
(0.46 to 1.17)

576
(4 studies)

⊕⊕⊝⊝
low

452 per 1000

330 per 1000
(208 to 529)

Moderate

409 per 1000

299 per 1000
(188 to 479)

Infection
Number of participants diagnosed with infection
Follow‐up: 12 months

Study population

RR 0.99
(0.79 to 1.24)

545
(3 studies)

⊕⊕⊝⊝
low

395 per 1000

391 per 1000
(312 to 490)

Moderate

367 per 1000

363 per 1000
(290 to 455)

Cytomegalovirus infection
Number of patients diagnosed with CMV infection
Follow‐up: 12 months

Study population

RR 0.86
(0.63 to 1.19)

606
(5 studies)

⊕⊕⊝⊝
low

221 per 1000

190 per 1000
(140 to 264)

Moderate

226 per 1000

194 per 1000
(142 to 269)

Post‐transplantation lymphoproliferative disorder
Number of participants diagnosed with PTLD
Follow‐up: 12 months

Study population

RR 0.74
(0.14 to 3.82)

606
(5 studies)

⊕⊕⊝⊝
low

10 per 1000

7 per 1000
(1 to 37)

Moderate

5 per 1000

4 per 1000
(1 to 19)

Cancer
Number of participants diagnosed with cancer
Follow‐up: 12 months

Study population

RR 1.01
(0.45 to 2.28)

576
(4 studies)

⊕⊕⊝⊝
low

38 per 1000

38 per 1000
(17 to 86)

Moderate

0 per 1000

0 per 1000
(0 to 0)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: further research is very unlikely to change our confidence in the estimate of effect
Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate
Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate
Very low quality: we are very uncertain about the estimate

1All trials with high risk of bias according to the Cochrane risk of bias assessment tool

Abbreviations: CMV = Cytomegalovirus; PTLD = post‐transplantation lymphoproliferative disorder

Figures and Tables -
Summary of findings for the main comparison. Antibody induction for heart transplant recipients
Summary of findings 2. Interleukin‐2 RA compared to no induction for heart transplant recipients

Interleukin‐2 RA compared to no induction for heart transplant recipients

Patient or population: heart transplant recipients
Settings: hospital
Intervention: interleukin‐2 RA
Comparison: no induction

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)1

Comments

Assumed risk

Corresponding risk

No induction

Interleukin‐2 RA

Mortality
Mortality at latest follow‐up
Follow‐up: 12 months

Study population

RR 1.53
(0.85 to 2.76)

576
(4 studies)

⊕⊕⊝⊝
low

62 per 1000

94 per 1000
(52 to 170)

Moderate

59 per 1000

90 per 1000
(50 to 163)

Acute rejection
Acute rejection grade 3A or more verified by biopsy
Follow‐up: 12 months

Study population

RR 0.73
(0.46 to 1.17)

576
(4 studies)

⊕⊕⊝⊝
low

452 per 1000

330 per 1000
(208 to 529)

Moderate

409 per 1000

299 per 1000
(188 to 479)

Infection
Number of participants diagnosed with infection
Follow‐up: 12 months

Study population

RR 0.99
(0.79 to 1.24)

545
(3 studies)

⊕⊕⊝⊝
low

395 per 1000

391 per 1000
(312 to 490)

Moderate

367 per 1000

363 per 1000
(290 to 455)

Cytomegalovirus infection
Number of participants diagnosed with CMV infection
Follow‐up: 12 months

Study population

RR 0.86
(0.62 to 1.19)

576
(4 studies)

⊕⊕⊝⊝
low

229 per 1000

197 per 1000
(142 to 273)

Moderate

228 per 1000

196 per 1000
(141 to 271)

Post‐transplantation lymphoproliferative disorder
Number of participants diagnosed with PTLD
Follow‐up: 12 months

Study population

RR 0.61
(0.08 to 4.92)

576
(4 studies)

⊕⊕⊝⊝
low

7 per 1000

4 per 1000
(1 to 34)

Moderate

2 per 1000

1 per 1000
(0 to 10)

Cancer
Number of participants diagnosed with cancer
Follow‐up: 12 months

Study population

RR 1.01
(0.45 to 2.28)

576
(4 studies)

⊕⊕⊝⊝
low

38 per 1000

38 per 1000
(17 to 86)

Moderate

0 per 1000

0 per 1000
(0 to 0)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: further research is very unlikely to change our confidence in the estimate of effect
Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate
Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate
Very low quality: we are very uncertain about the estimate

1All trials with high risk of bias according to the Cochrane risk of bias assessment tool

Abbreviations: CMV = Cytomegalovirus; PTLD = post‐transplantation lymphoproliferative disorder

Figures and Tables -
Summary of findings 2. Interleukin‐2 RA compared to no induction for heart transplant recipients
Summary of findings 3. Interleukin‐2 RA induction compared to monoclonal antibody induction for heart transplant recipients

Interleukin‐2 RA induction compared to monoclonal antibody induction for heart transplant recipients

Patient or population: heart transplant recipients
Settings: hospital
Intervention: interleukin‐2 RA induction
Comparison: monoclonal antibody induction

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)1

Comments

Assumed risk

Corresponding risk

Monoclonal antibody (other than IL‐2 RA)induction

Interleukin‐2 RA induction

Mortality
Mortality at latest follow‐up
Follow‐up: 1‐10 years

Study population

RR 0.8
(0.19 to 3.41)

159
(2 studies)

⊕⊕⊝⊝
low1

212 per 1000

170 per 1000
(40 to 725)

Moderate

226 per 1000

181 per 1000
(43 to 771)

Acute rejection
Acute rejection grade 3A or more verified by biopsy
Follow‐up: 1‐10 years

Study population

RR 0.97
(0.77 to 1.23)

159
(2 studies)

⊕⊕⊝⊝
low

550 per 1000

534 per 1000
(423 to 677)

Moderate

602 per 1000

584 per 1000
(464 to 740)

Infection
Number of participants diagnosed with infection
Follow‐up: 1‐10 years

Study population

RR 0.91
(0.54 to 1.53)

159
(2 studies)

⊕⊕⊝⊝
low

638 per 1000

580 per 1000
(344 to 975)

Moderate

589 per 1000

536 per 1000
(318 to 901)

Cytomegalovirus infection
Number of participants diagnosed with CMV infection
Follow‐up: 1‐10 years

Study population

RR 0.94
(0.43 to 2.06)

159
(2 studies)

⊕⊕⊝⊝
low

288 per 1000

270 per 1000
(124 to 592)

Moderate

233 per 1000

219 per 1000
(100 to 480)

Post‐transplantation lymphoproliferative disorder
Number of participants diagnosed with PTLD
Follow‐up: 1‐10 years

Study population

RR 0.31
(0.01 to 7.38)

159
(2 studies)

⊕⊕⊝⊝
low

12 per 1000

4 per 1000
(0 to 92)

Moderate

17 per 1000

5 per 1000
(0 to 125)

Cancer
Number of participants diagnosed with cancer
Follow‐up: 1‐10 years

Study population

RR 0.84
(0.4 to 1.77)

159
(2 studies)

⊕⊕⊝⊝
low1

125 per 1000

105 per 1000
(50 to 221)

Moderate

172 per 1000

144 per 1000
(69 to 304)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: further research is very unlikely to change our confidence in the estimate of effect
Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate
Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate
Very low quality: we are very uncertain about the estimate

1 All trials with high risk of bias according to the Cochrane risk of bias assessment tool

Abbreviations: CMV = Cytomegalovirus; PTLD = post‐transplantation lymphoproliferative disorder

Figures and Tables -
Summary of findings 3. Interleukin‐2 RA induction compared to monoclonal antibody induction for heart transplant recipients
Summary of findings 4. Interleukin‐2 RA versus polyclonal antibody induction for heart transplant recipients

Interleukin‐2 RA versus polyclonal antibody induction for heart transplant recipients

Patient or population: heart transplant recipients
Settings: hospital
Intervention: interleukin‐2 RA
Comparison: polyclonal antibody

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)1

Comments

Assumed risk

Corresponding risk

Polyclonal antibody

Interleukin‐2 RA

Mortality
Mortality at latest follow‐up
Follow‐up: 1‐10 years

Study population

RR 1.1
(0.65 to 1.88)

185
(4 studies)

⊕⊕⊝⊝
low1

221 per 1000

243 per 1000
(144 to 416)

Moderate

218 per 1000

240 per 1000
(142 to 410)

Acute rejection
Acute rejection grade 3A or more verified by biopsy
Follow‐up: 1‐10 years

Study population

RR 2.43
(1.01 to 5.86)

185
(4 studies)

⊕⊕⊝⊝
low

105 per 1000

256 per 1000
(106 to 617)

Moderate

117 per 1000

284 per 1000
(118 to 686)

Infection
Number of participants diagnosed with infection
Follow‐up: 1‐10 years

Study population

RR 0.85
(0.71 to 1.03)

155
(3 studies)

⊕⊕⊝⊝
low

800 per 1000

680 per 1000
(568 to 824)

Moderate

778 per 1000

661 per 1000
(552 to 801)

Cytomegalovirus infection
Number of participants diagnosed with CMV infection
Follow‐up: 1‐10 years

Study population

RR 0.97
(0.53 to 1.75)

185
(4 studies)

⊕⊕⊝⊝
low

200 per 1000

194 per 1000
(106 to 350)

Moderate

186 per 1000

180 per 1000
(99 to 326)

Post‐transplantation lymphoproliferative disorder
Number of participants diagnosed with PTLD
Follow‐up: 1‐10 years

See comment

See comment

Not estimable

185
(4 studies)

⊕⊕⊝⊝
low

Cancer
Number of participants diagnosed with cancer
Follow‐up: 1‐10 years

Study population

RR 9
(0.52 to 156.91)

185
(4 studies)

⊕⊕⊝⊝
low

0 per 1000

0 per 1000
(0 to 0)

Moderate

0 per 1000

0 per 1000
(0 to 0)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: further research is very unlikely to change our confidence in the estimate of effect
Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate
Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate
Very low quality: we are very uncertain about the estimate

1 All trials with high risk of bias according to the Cochrane risk of bias assessment tool

Abbreviations: CMV = Cytomegalovirus; PTLD = post‐transplantation lymphoproliferative disorder

Figures and Tables -
Summary of findings 4. Interleukin‐2 RA versus polyclonal antibody induction for heart transplant recipients
Summary of findings 5. Monoclonal antibody compared to polyclonal antibody for heart transplant recipients

Monoclonal antibody compared to polyclonal antibody for heart transplant recipients

Patient or population: heart transplant recipients
Settings: hospital
Intervention: monoclonal antibody
Comparison: polyclonal antibody

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)1

Comments

Assumed risk

Corresponding risk

Polyclonal antibody

Monoclonal antibody

Mortality
Mortality at latest follow‐up
Follow‐up: 6‐15 months

Study population

RR 1
(0.9 to 1.1)

315
(7 studies)

⊕⊕⊝⊝
low

277 per 1000

277 per 1000
(250 to 305)

Moderate

182 per 1000

182 per 1000
(164 to 200)

Acute rejection
Acute rejection grade 3A or more verified by biopsy
Follow‐up: 12 months

Study population

RR 0.96
(0.67 to 1.37)

146
(3 studies)

⊕⊕⊝⊝
low

648 per 1000

622 per 1000
(434 to 888)

Moderate

762 per 1000

732 per 1000
(511 to 1000)

Infection
Number of participants diagnosed with infection
Follow‐up: 6‐12 months

Study population

RR 1.12
(0.91 to 1.39)

214
(5 studies)

⊕⊕⊝⊝
low1

462 per 1000

517 per 1000
(420 to 642)

Moderate

526 per 1000

589 per 1000
(479 to 731)

Cytomegalovirus infection
Number of participants diagnosed with CMV infection
Follow‐up: 12‐15 months

Study population

RR 1.32
(0.77 to 2.28)

201
(4 studies)

⊕⊕⊝⊝
low

162 per 1000

213 per 1000
(124 to 368)

Moderate

162 per 1000

214 per 1000
(125 to 369)

Post‐transplantation lymphoproliferative disorder
Number of participants diagnosed with PTLD
Follow‐up: mean 6‐15 months

Study population

RR 3.84
(0.45 to 32.96)

157
(4 studies)

⊕⊕⊝⊝
low

0 per 1000

0 per 1000
(0 to 0)

Moderate

0 per 1000

0 per 1000
(0 to 0)

Cancer
Number of participants diagnosed with cancer
Follow‐up: mean 6‐15 months

Study population

RR 2.19
(0.51 to 9.43)

157
(4 studies)

⊕⊕⊝⊝
low1

26 per 1000

56 per 1000
(13 to 242)

Moderate

18 per 1000

39 per 1000
(9 to 170)

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: further research is very unlikely to change our confidence in the estimate of effect
Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate
Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate
Very low quality: we are very uncertain about the estimate

1 All trials with high risk of bias according to the Cochrane risk of bias assessment tool

Abbreviations: CMV = Cytomegalovirus; PTLD = post‐transplantation lymphoproliferative disorder

Figures and Tables -
Summary of findings 5. Monoclonal antibody compared to polyclonal antibody for heart transplant recipients
Comparison 1. Antibody induction versus no induction

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

5

606

Risk Ratio (M‐H, Random, 95% CI)

1.53 [0.85, 2.76]

1.1 Interleukin‐2 receptor antagonists (IL‐2 RAs)

4

576

Risk Ratio (M‐H, Random, 95% CI)

1.53 [0.85, 2.76]

1.2 Monoclonal antibody

1

30

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2 Acute rejection Show forest plot

4

576

Risk Ratio (M‐H, Random, 95% CI)

0.73 [0.46, 1.17]

2.1 IL‐2 RA

4

576

Risk Ratio (M‐H, Random, 95% CI)

0.73 [0.46, 1.17]

3 Infection Show forest plot

3

545

Risk Ratio (M‐H, Random, 95% CI)

0.99 [0.79, 1.24]

3.1 IL‐2 RA

3

545

Risk Ratio (M‐H, Random, 95% CI)

0.99 [0.79, 1.24]

4 Cytomegalovirus infection Show forest plot

5

606

Risk Ratio (M‐H, Random, 95% CI)

0.86 [0.63, 1.19]

4.1 IL‐2 RA

4

576

Risk Ratio (M‐H, Random, 95% CI)

0.86 [0.62, 1.19]

4.2 Monoclonal antibody

1

30

Risk Ratio (M‐H, Random, 95% CI)

1.0 [0.07, 14.55]

5 Post‐transplantation lymphoproliferative disorder Show forest plot

5

606

Risk Ratio (M‐H, Random, 95% CI)

0.74 [0.14, 3.82]

5.1 IL‐2 RA

4

576

Risk Ratio (M‐H, Random, 95% CI)

0.61 [0.08, 4.92]

5.2 Monoclonal antibody

1

30

Risk Ratio (M‐H, Random, 95% CI)

1.0 [0.07, 14.55]

6 Cancer Show forest plot

4

576

Risk Ratio (M‐H, Random, 95% CI)

1.01 [0.45, 2.28]

6.1 IL‐2 RA

4

576

Risk Ratio (M‐H, Random, 95% CI)

1.01 [0.45, 2.28]

7 Adverse events Show forest plot

2

111

Risk Ratio (M‐H, Random, 95% CI)

1.37 [0.99, 1.90]

7.1 IL‐2 RA

2

111

Risk Ratio (M‐H, Random, 95% CI)

1.37 [0.99, 1.90]

8 Chronic allograft vasculopathy Show forest plot

1

30

Risk Ratio (M‐H, Random, 95% CI)

1.0 [0.07, 14.55]

8.1 Monoclonal antibody

1

30

Risk Ratio (M‐H, Random, 95% CI)

1.0 [0.07, 14.55]

9 Renal failure requiring chronic dialysis Show forest plot

1

30

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

9.1 Monoclonal antibody

1

30

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

10 Serum creatinine Show forest plot

1

30

Mean Difference (IV, Random, 95% CI)

26.50 [‐2.16, 55.16]

10.1 Monoclonal antibody

1

30

Mean Difference (IV, Random, 95% CI)

26.50 [‐2.16, 55.16]

11 Hypertension Show forest plot

1

56

Risk Ratio (M‐H, Random, 95% CI)

0.94 [0.71, 1.25]

Figures and Tables -
Comparison 1. Antibody induction versus no induction
Comparison 2. Interleukin‐2 receptor antagonist (IL‐2 RA) versus no induction

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

4

576

Risk Ratio (M‐H, Random, 95% CI)

1.53 [0.85, 2.76]

1.1 Basiliximab

1

56

Risk Ratio (M‐H, Random, 95% CI)

3.72 [0.41, 33.61]

1.2 Daclizumab

3

520

Risk Ratio (M‐H, Random, 95% CI)

1.36 [0.67, 2.74]

2 Acute rejection Show forest plot

4

576

Risk Ratio (M‐H, Random, 95% CI)

0.73 [0.46, 1.17]

2.1 Basiliximab

1

56

Risk Ratio (M‐H, Random, 95% CI)

1.35 [0.72, 2.53]

2.2 Daclizumab

3

520

Risk Ratio (M‐H, Random, 95% CI)

0.62 [0.40, 0.96]

3 Infection Show forest plot

3

545

Risk Ratio (M‐H, Random, 95% CI)

0.99 [0.79, 1.24]

3.1 Basiliximab

1

56

Risk Ratio (M‐H, Random, 95% CI)

1.13 [0.87, 1.48]

3.2 Daclizumab

2

489

Risk Ratio (M‐H, Random, 95% CI)

0.88 [0.69, 1.13]

4 Cytomegalovirus infection Show forest plot

4

576

Risk Ratio (M‐H, Random, 95% CI)

0.86 [0.62, 1.19]

4.1 Basiliximab

1

56

Risk Ratio (M‐H, Random, 95% CI)

0.71 [0.23, 2.15]

4.2 Daclizumab

3

520

Risk Ratio (M‐H, Random, 95% CI)

0.87 [0.51, 1.49]

5 Post‐transplantation lymphoproliferative disorder Show forest plot

4

576

Risk Ratio (M‐H, Random, 95% CI)

0.61 [0.08, 4.92]

5.1 Basiliximab

1

56

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5.2 Daclizumab

3

520

Risk Ratio (M‐H, Random, 95% CI)

0.61 [0.08, 4.92]

6 Cancer Show forest plot

4

576

Risk Ratio (M‐H, Random, 95% CI)

1.01 [0.45, 2.28]

6.1 Basiliximab

1

56

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6.2 Daclizumab

3

520

Risk Ratio (M‐H, Random, 95% CI)

1.01 [0.45, 2.28]

7 Adverse events Show forest plot

2

111

Risk Ratio (M‐H, Random, 95% CI)

1.37 [0.99, 1.90]

7.1 Basiliximab

1

56

Risk Ratio (M‐H, Random, 95% CI)

1.37 [0.99, 1.90]

7.2 Daclizumab

1

55

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

8 Hypertension Show forest plot

1

56

Risk Ratio (M‐H, Random, 95% CI)

0.94 [0.71, 1.25]

8.1 Basiliximab

1

56

Risk Ratio (M‐H, Random, 95% CI)

0.94 [0.71, 1.25]

Figures and Tables -
Comparison 2. Interleukin‐2 receptor antagonist (IL‐2 RA) versus no induction
Comparison 3. Interleukin‐2 receptor antagonist (IL‐2 RA) versus monoclonal antibody

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

2

159

Risk Ratio (M‐H, Random, 95% CI)

0.80 [0.19, 3.41]

1.1 Basiliximab

1

99

Risk Ratio (M‐H, Random, 95% CI)

0.35 [0.10, 1.23]

1.2 BT563

1

60

Risk Ratio (M‐H, Random, 95% CI)

1.52 [0.74, 3.13]

2 Acute rejection Show forest plot

2

159

Risk Ratio (M‐H, Random, 95% CI)

0.97 [0.77, 1.23]

2.1 Basiliximab

1

99

Risk Ratio (M‐H, Random, 95% CI)

0.96 [0.60, 1.55]

2.2 BT563

1

60

Risk Ratio (M‐H, Random, 95% CI)

0.98 [0.75, 1.27]

3 Infection Show forest plot

2

159

Risk Ratio (M‐H, Random, 95% CI)

0.91 [0.54, 1.53]

3.1 Basiliximab

1

99

Risk Ratio (M‐H, Random, 95% CI)

0.74 [0.55, 0.99]

3.2 BT563

1

60

Risk Ratio (M‐H, Random, 95% CI)

1.25 [0.72, 2.16]

4 Cytomegalovirus infection Show forest plot

2

159

Risk Ratio (M‐H, Random, 95% CI)

0.94 [0.43, 2.06]

4.1 Basiliximab

1

99

Risk Ratio (M‐H, Random, 95% CI)

0.82 [0.50, 1.35]

4.2 BT563

1

60

Risk Ratio (M‐H, Random, 95% CI)

2.81 [0.31, 25.48]

5 Post‐transplantation lymphoproliferative disorder Show forest plot

2

159

Risk Ratio (M‐H, Random, 95% CI)

0.31 [0.01, 7.38]

5.1 Basiliximab

1

99

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5.2 BT563

1

60

Risk Ratio (M‐H, Random, 95% CI)

0.31 [0.01, 7.38]

6 Cancer Show forest plot

2

159

Risk Ratio (M‐H, Random, 95% CI)

0.84 [0.40, 1.77]

6.1 Basiliximab

1

99

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6.2 BT563

1

60

Risk Ratio (M‐H, Random, 95% CI)

0.84 [0.40, 1.77]

7 Adverse events Show forest plot

1

99

Risk Ratio (M‐H, Random, 95% CI)

0.01 [0.00, 0.18]

7.1 Basiliximab

1

99

Risk Ratio (M‐H, Random, 95% CI)

0.01 [0.00, 0.18]

Figures and Tables -
Comparison 3. Interleukin‐2 receptor antagonist (IL‐2 RA) versus monoclonal antibody
Comparison 4. Interleukin‐2 receptor antagonist (IL‐2 RA) versus polyclonal antibody

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

4

185

Risk Ratio (M‐H, Random, 95% CI)

1.10 [0.65, 1.88]

1.1 Basiliximab

2

115

Risk Ratio (M‐H, Random, 95% CI)

0.77 [0.35, 1.66]

1.2 Daclizumab

1

30

Risk Ratio (M‐H, Random, 95% CI)

1.0 [0.16, 6.20]

1.3 BT563

1

40

Risk Ratio (M‐H, Random, 95% CI)

1.67 [0.75, 3.71]

2 Acute rejection Show forest plot

4

185

Risk Ratio (M‐H, Random, 95% CI)

2.43 [1.01, 5.86]

2.1 Basiliximab

2

115

Risk Ratio (M‐H, Random, 95% CI)

2.33 [0.96, 5.62]

2.2 Daclizumab

1

30

Risk Ratio (M‐H, Random, 95% CI)

0.20 [0.01, 3.85]

2.3 BT563

1

40

Risk Ratio (M‐H, Random, 95% CI)

5.5 [1.39, 21.71]

3 Infection Show forest plot

3

155

Risk Ratio (M‐H, Random, 95% CI)

0.85 [0.71, 1.03]

3.1 Basiliximab

2

115

Risk Ratio (M‐H, Random, 95% CI)

0.87 [0.71, 1.07]

3.2 BT563

1

40

Risk Ratio (M‐H, Random, 95% CI)

0.8 [0.52, 1.24]

4 Cytomegalovirus infection Show forest plot

4

185

Risk Ratio (M‐H, Random, 95% CI)

0.97 [0.53, 1.75]

4.1 Basiliximab

2

115

Risk Ratio (M‐H, Random, 95% CI)

0.81 [0.36, 1.81]

4.2 Daclizumab

1

30

Risk Ratio (M‐H, Random, 95% CI)

0.5 [0.05, 4.94]

4.3 BT563

1

40

Risk Ratio (M‐H, Random, 95% CI)

1.4 [0.53, 3.68]

5 Post‐transplantation lymphoproliferative disorder Show forest plot

4

185

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5.1 Basiliximab

2

115

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5.2 Daclizumab

1

30

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5.3 BT563

1

40

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6 Cancer Show forest plot

4

185

Risk Ratio (M‐H, Random, 95% CI)

9.00 [0.52, 156.91]

6.1 Basiliximab

2

115

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6.2 Daclizumab

1

30

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6.3 BT563

1

40

Risk Ratio (M‐H, Random, 95% CI)

9.00 [0.52, 156.91]

7 Adverse events Show forest plot

3

150

Risk Ratio (M‐H, Random, 95% CI)

0.38 [0.21, 0.70]

7.1 Basiliximab

1

80

Risk Ratio (M‐H, Random, 95% CI)

0.38 [0.21, 0.71]

7.2 Daclizumab

1

30

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7.3 BT563

1

40

Risk Ratio (M‐H, Random, 95% CI)

0.33 [0.01, 7.72]

8 Chronic allograft vasculopathy Show forest plot

2

70

Risk Ratio (M‐H, Random, 95% CI)

2.0 [0.72, 5.59]

8.1 Daclizumab

1

30

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

8.2 BT563

1

40

Risk Ratio (M‐H, Random, 95% CI)

2.0 [0.72, 5.59]

Figures and Tables -
Comparison 4. Interleukin‐2 receptor antagonist (IL‐2 RA) versus polyclonal antibody
Comparison 5. Monoclonal antibody versus polyclonal antibody

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

7

315

Risk Ratio (M‐H, Random, 95% CI)

1.00 [0.90, 1.10]

1.1 Rabbit anti‐thymocyte globulin (RATG)

3

157

Risk Ratio (M‐H, Random, 95% CI)

1.05 [0.39, 2.82]

1.2 Horse anti‐thymocyte globulin (ATG)

2

64

Risk Ratio (M‐H, Random, 95% CI)

1.00 [0.35, 2.81]

1.3 Anti‐lymphocyte globulin (ALG)

2

94

Risk Ratio (M‐H, Random, 95% CI)

1.00 [0.90, 1.10]

2 Acute rejection Show forest plot

3

146

Risk Ratio (M‐H, Random, 95% CI)

0.96 [0.67, 1.37]

2.1 Rabbit anti‐thymocyte globulin (RATG)

1

82

Risk Ratio (M‐H, Random, 95% CI)

1.29 [0.87, 1.91]

2.2 Horse anti‐thymocyte globulin (ATG)

2

64

Risk Ratio (M‐H, Random, 95% CI)

0.83 [0.58, 1.19]

3 Infection Show forest plot

5

214

Risk Ratio (M‐H, Random, 95% CI)

1.12 [0.91, 1.39]

3.1 Rabbit anti‐thymocyte globulin (RATG)

3

152

Risk Ratio (M‐H, Random, 95% CI)

0.98 [0.69, 1.39]

3.2 Horse anti‐thymocyte globulin (ATG)

1

23

Risk Ratio (M‐H, Random, 95% CI)

1.21 [0.89, 1.66]

3.3 Anti‐lymphocyte globulin (ALG)

1

39

Risk Ratio (M‐H, Random, 95% CI)

1.24 [0.72, 2.11]

4 Cytomegalovirus infection Show forest plot

4

201

Risk Ratio (M‐H, Random, 95% CI)

1.32 [0.77, 2.28]

4.1 Rabbit anti‐thymocyte globulin (RATG)

1

82

Risk Ratio (M‐H, Random, 95% CI)

0.91 [0.13, 6.13]

4.2 Horse anti‐thymocyte globulin (ATG)

2

64

Risk Ratio (M‐H, Random, 95% CI)

1.57 [0.85, 2.89]

4.3 Anti‐lymphocyte globulin (ALG)

1

55

Risk Ratio (M‐H, Random, 95% CI)

0.52 [0.10, 2.60]

5 Post‐transplantation lymphoproliferative disorder Show forest plot

4

157

Risk Ratio (M‐H, Random, 95% CI)

3.84 [0.45, 32.96]

5.1 Horse anti‐thymocyte globulin (ATG)

2

63

Risk Ratio (M‐H, Random, 95% CI)

4.62 [0.25, 86.72]

5.2 Anti‐lymphocyte globulin (ALG)

2

94

Risk Ratio (M‐H, Random, 95% CI)

3.11 [0.13, 73.11]

6 Cancer Show forest plot

4

157

Risk Ratio (M‐H, Random, 95% CI)

2.19 [0.51, 9.43]

6.1 Horse anti‐thymocyte globulin (ATG)

2

63

Risk Ratio (M‐H, Random, 95% CI)

2.0 [0.20, 20.33]

6.2 Anti‐lymphocyte globulin (ALG)

2

94

Risk Ratio (M‐H, Random, 95% CI)

2.33 [0.36, 15.20]

7 Adverse events Show forest plot

5

215

Risk Ratio (M‐H, Random, 95% CI)

11.62 [0.37, 362.95]

7.1 Rabbit anti‐thymocyte globulin (RATG)

2

112

Risk Ratio (M‐H, Random, 95% CI)

55.45 [3.50, 877.43]

7.2 Horse anti‐thymocyte globulin (ATG)

2

64

Risk Ratio (M‐H, Random, 95% CI)

3.5 [1.12, 10.90]

7.3 Anti‐lymphocyte globulin (ALG)

1

39

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

8 Serum creatinine Show forest plot

2

105

Mean Difference (IV, Random, 95% CI)

9.95 [‐33.88, 53.78]

8.1 Rabbit anti‐thymocyte globulin (RATG)

1

82

Mean Difference (IV, Random, 95% CI)

‐9.70 [‐11.80, ‐7.60]

8.2 Horse anti‐thymocyte globulin (ATG)

1

23

Mean Difference (IV, Random, 95% CI)

35.40 [3.64, 67.16]

Figures and Tables -
Comparison 5. Monoclonal antibody versus polyclonal antibody
Comparison 6. Anti‐thymocyte globulin (ATG) versus anti‐lymphocyte globulin (ALG)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

1

42

Risk Ratio (M‐H, Random, 95% CI)

1.21 [0.08, 18.09]

2 Infection Show forest plot

1

42

Risk Ratio (M‐H, Random, 95% CI)

2.22 [1.01, 4.88]

3 Adverse events Show forest plot

1

42

Risk Ratio (M‐H, Random, 95% CI)

0.40 [0.02, 9.29]

Figures and Tables -
Comparison 6. Anti‐thymocyte globulin (ATG) versus anti‐lymphocyte globulin (ALG)
Comparison 7. High‐dose anti‐thymocyte globulin (ATG) versus standard‐dose

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

2 Acute rejection Show forest plot

1

30

Risk Ratio (M‐H, Random, 95% CI)

1.43 [0.47, 4.30]

3 Infection Show forest plot

1

30

Risk Ratio (M‐H, Random, 95% CI)

0.86 [0.39, 1.87]

4 Cytomegalovirus infection Show forest plot

1

30

Risk Ratio (M‐H, Random, 95% CI)

1.14 [0.27, 4.78]

5 Post‐transplantation lymphoproliferative disorder Show forest plot

1

30

Risk Ratio (M‐H, Random, 95% CI)

0.38 [0.02, 8.59]

6 Cancer Show forest plot

1

30

Risk Ratio (M‐H, Random, 95% CI)

0.57 [0.06, 5.65]

7 Adverse events Show forest plot

1

30

Risk Ratio (M‐H, Random, 95% CI)

1.71 [0.60, 4.86]

8 Chronic allograft vasculopathy Show forest plot

1

30

Risk Ratio (M‐H, Random, 95% CI)

0.57 [0.22, 1.50]

9 Renal failure requiring chronic dialysis Show forest plot

1

30

Risk Ratio (M‐H, Random, 95% CI)

0.23 [0.01, 4.36]

10 Mortality Show forest plot

1

30

Risk Ratio (M‐H, Random, 95% CI)

0.57 [0.06, 5.65]

Figures and Tables -
Comparison 7. High‐dose anti‐thymocyte globulin (ATG) versus standard‐dose
Comparison 8. RATG‐Thymoglobulin versus RATG‐Fresenius

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mortality Show forest plot

2

90

Risk Ratio (M‐H, Random, 95% CI)

1.18 [0.34, 4.06]

2 Acute rejection Show forest plot

2

90

Risk Ratio (M‐H, Random, 95% CI)

1.05 [0.48, 2.26]

3 Infection Show forest plot

2

90

Risk Ratio (M‐H, Random, 95% CI)

0.80 [0.55, 1.18]

4 Cytomegalovirus infection Show forest plot

2

90

Risk Ratio (M‐H, Random, 95% CI)

1.69 [0.10, 28.16]

5 Post‐transplantation lymphoproliferative disorder Show forest plot

1

40

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6 Cancer Show forest plot

1

40

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7 Adverse events Show forest plot

2

90

Risk Ratio (M‐H, Random, 95% CI)

1.5 [0.28, 8.04]

8 Chronic allograft vasculopathy Show forest plot

1

16

Risk Ratio (M‐H, Random, 95% CI)

0.78 [0.14, 4.23]

Figures and Tables -
Comparison 8. RATG‐Thymoglobulin versus RATG‐Fresenius