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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