Non-English NVP-LDE225 price articles were translated by a medical specialist fluent in the respective languages. All prospective, controlled, experimental (randomized), and observational (nonrandomized) studies in which IL-2Ra induction therapy in liver transplant recipients was compared with placebo or no treatment were included. For comparison
1, we included only studies in which IL-2Ra was compared to placebo or no treatment with otherwise the same immunosuppressive treatment in both study arms. For comparison 2, we included studies with reduced and/or delayed CNI in combination with IL-2Ra; and in comparison 3, we included studies with reduced corticosteroids in combination with IL-2Ra. Other immunosuppressive medication, e.g., mycophenolate mofetil, had to be the same in both treatment arms. Studies with historical controls were also included, but we excluded studies in which both cohorts were assessed retrospectively. We also
excluded noncontrolled studies and pharmacological studies that did not provide data on clinical outcome measures because of their very short follow-up time. With regard to patient selection, we excluded trials with patients undergoing multiorgan transplantation or retransplantation. The primary outcomes analyzed were graft loss, acute rejection, steroid-resistant rejection, and death. Other outcome measures assessed were renal dysfunction selleck compound (serum creatinine and/or estimated glomerular filtration rate [eGFR]), de novo malignancy (excluding recurrence of hepatocellular
carcinoma), PTLD, infectious complications, including cytomegalovirus (CMV) infection, new onset of metabolic and cardiovascular disorders, such as hypertension, hyperlipoproteinemia, and posttransplant diabetes mellitus (PTDM), and all other adverse reactions (as a direct consequence of drug treatment). There were four reviewers (A.D.G., A.O., N.H., N.B.). The literature search strategy was designed and selleck chemical performed by three reviewers (A.D.G., A.O., N.H.). The search results were combined in an open source reference management software (JabRef v. 2.6.0). Publications were screened independently by three reviewers (A.D.G., N.H., N.B.). Disagreement and any discrepancies were resolved by discussion (A.O. with A.D.G., N.H., N.B.). Data extraction was performed by two reviewers (A.D.G., N.H.), using a standardized form. A training set was used to validate data extraction. Quality of studies was assessed independently by two reviewers (A.D.G., N.H.) without blinding to journal and authorship. The quality items assessed were blinding, randomization, allocation concealment, intention-to-treat analysis (ITT), completeness of follow-up, and the method of handling missing values. Assessment was performed according to definitions stated in the Cochrane Handbook.8 Furthermore, completeness of follow-up was defined as the number of patients that were not lost to follow-up.