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Table 2 Post-operative fatal and non-fatal outcomes in kidney transplant patients compared to non-transplant patients and grading of the certainty of evidence using GRADE

From: Postoperative outcomes of kidney transplant recipients undergoing non-transplant-related elective surgery: a systematic review and meta-analysis

Outcomes (Number of Studies) Events in kidney transplant patients Events in non-transplanted patients Certainty of evidence (GRADE) Rationale
Risk of bias Inconsistency Indirectness Imprecision Publication bias Strong association
30 day/In-hospital mortality (8) 449/8151 79,978/3,272,453 Low a,d,g,f
Myocardial infarction (4) 104/4793 55,029/3,088,295 Very low a,b,c,g ↓↓ ↓↓
Stroke (7) 91/7636 54,508/4,794,679 Very low a,b,c,g ↓↓ ↓↓
Cardiac failure (3) 1109/7129 126,004/1,848,386 Very low a,c,g ↓↓
Surgical site infection (8) 293/8360 85,747/3,536,106 Very low a,b,c,g ↓↓
Pneumonia (8) 693/8151 196,982/3,272,453 Very low a,c,g ↓↓
Sepsis (5) 692/4019 15,951/164,139 Low a,c,g,f
Gastrointestinal events (6) 495/8006 414,890/3,272,004 Very lowa,c,g,h ↓↓
Blood transfusion (5) 2056/7505 424,174/3,087,470 Very lowa,c,g,h
Unplanned return to theatre (6) 53/395 75/1524 Very lowa,b,g ↓↓
AKI (11) 2205/15,371 316,667/7,807,595 Moderate a,c,e,g ↓↓ ↑↑
PE/DVT (3) 204/4723 81,226/3,087,400 Very low a,b,c,g ↓↓ ↓↓
  1. aCertainty of evidence downgraded due to concerns of poor comparability between study cohorts
  2. bCertainty of evidence downgraded for imprecision, due to few events and wide confidence intervals
  3. cCertainty of evidence downgraded for inconsistency due to significant heterogeneity that remained unexplained (ranged between 67% and 98%)
  4. dCertainty of evidence not downgraded due to significant heterogeneity being explained by surgical disciplines and higher prevalence of diabetes in kidney transplant patients
  5. eCertainty of evidence upgraded due to large (>5 fold) risk estimate
  6. fCertainty of evidence upgraded due to large (>2 fold) risk estimate
  7. g Publication bias not judged to assess certainty of evidence due to small study numbers (<10)
  8. hCertainty of evidence not downgraded for imprecision due to significant number of events in both groups