3) shows significant

effect of daclizumab (RR 0.82; CI 0.71-0.95; P = 0.007; 12 trials/cohorts) but not basiliximab (RR 0.87; CI 0.73-1.03; P = 0.11; seven trials), but this Dabrafenib mw does not seem to be a systematic effect because meta-regression does not indicate a significant effect of type of IL-2Ra (P for test of moderators = 0.67; Table 3) and inspection of the funnel plot (Supporting Fig. 4) shows that both types of studies are distributed similarly. Meta-regression also showed that concomitant use of MMF (in both arms) seems to amplify the effect of IL-2Ra (ratio of RR 0.83; CI 0.69-1.01; P = 0.06). Analysis of the type of CNI did not show significant effects, but trials in comparison 2 also had a lower RR compared to trials in comparison 1 (Table 3). This effect may be explained by the fact that MMF was used in all trials in comparison 2. After adjusting for MMF, the effect in comparison 2 alone is no longer

seen. We did not RO4929097 nmr observe significant heterogeneity in any of the analyses and observed only marginal changes of residual heterogeneity in meta-regression (Table 3). However, we observed considerable heterogeneity of overall rejection rates (i.e., the sums in the experimental and control groups of each trial) ranging from over 55%36 to less than 10%38 (see Supporting Table 2). Similar differences have also been observed in other meta-analyses concerning organ transplantation.42 We sought sources of heterogeneity using GLMM and found that the overall rejection rate was significantly higher in studies that required protocol biopsies (OR 3.10;

CI 1.93-4.99; P < 0.001; 19 trials/cohorts). These studies reported not only treated rejections but also histological signs of rejection without clinical correlates. Subgroup analysis of trials with and without protocol biopsies (five trials/cohorts with 435 patients and 14 trials with 2,526 patients, respectively) showed a significant effect on acute rejection only in studies without protocol biopsies (RR 0.81; CI 0.71-0.92) but not in studies that performed protocol biopsies (RR 0.92; CI 0.76-1.11). Meta-regression does not provide any evidence for a significant MCE公司 effect of protocol biopsies on acute rejection (P value for test of moderators 0.26) and the inspection of the funnel plot (Supporting Fig. 5) shows that the distribution of both groups of studies is comparable. Furthermore, the analysis of overall rejection rate showed that the use of MMF decreased the incidence of acute rejection in both study arms (OR 0.49; CI 0.31-0.77; P = 0.002; 19 trials/cohorts). After adjustment for use of MMF and type of biopsy the effect of IL-2Ra was still highly significant (OR 0.76; CI 0.64-0.90; P = 0.002; 19 trials/cohorts). Funnel plot analysis for acute rejection showed significant asymmetry (P = 0.01). Using the trim-and-fill method we augmented the data (Supporting Fig. 6) and these supposedly missing studies all had a risk ratio above 1.