Maintenance immunosuppression for adults undergoing liver transplantation: a network meta-analysis.
Rodriguez-Peralvarez M, Guerrero-Misas M, et al.Cochrane Database of Systematic Reviews 2017; 3: CD011639.
Aims
To conduct a systematic review and meta-analysis to compare the benefits and harms of different maintenance immunosuppressive regimens in adults undergoing liver transplantation and rank these according to their safety and efficacy.
Interventions
The Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and Science Citation Index Expanded were searched from inception until 26th October 2016 for studies with maintenance immunosuppressive regimens after liver transplantation compared with each other. Only randomised clinical trials with adult participants undergoing liver transplantation were considered for inclusion and all trials were independently identified by two review authors.
Participants
26 trials involving 3,842 participants were included in this review.
Outcomes
Primary outcomes measured were mortality, graft loss, adverse events and health-related quality of life. Secondary outcomes measured were retransplantation, acute graft rejections and costs.
Follow-up
Ranged from 3 to 144 months
CET Conclusions
This careful Cochrane network meta-analysis assesses the benefits and harms of different immunosuppressive regimens after liver transplantation. Twenty-six trials met the inclusion criteria and were included in the qualitative synthesis of which 23 trials were included in the quantitative synthesis. Risk of bias of trials was assessed using the Cochrane Risk of Bias tool and the quality of the evidence of the network meta-analysis was also assessed using the GRADE methodology. The risk of bias of trials was high or unclear for most trials and the quality of the evidence of the network meta-analysis was mostly rated as very low. The authors conclude that based on the very-low quality of the evidence no evidence was found for differences in terms of risk of death or graft loss between immunosuppressive regimens and they stressed the need for robust future randomised controlled trials including representative study populations.
Quality notes
Quality assessment not appropriate
Trial registration
None