Evidence map›Paper›PMID 25422259›Full record

SynthesisBMJ (Clinical research ed.)2014

Effect of sirolimus on malignancy and survival after kidney transplantation: systematic review and meta-analysis of individual patient data.

Greg A Knoll, Madzouka B Kokolo, Ranjeeta Mallick, Andrew Beck, Chieny D Buenaventura, Robin Ducharme, Rashad Barsoum, Corrado Bernasconi, Tom D Blydt-Hansen, Henrik Ekberg and 14 more

Erratum issuedOpen access · hybridAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ (Clinical research ed.), 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 101 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
101citing papers in PubMed, 3 pooled it
23.3field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

101 citing papers in PubMed, 3 syntheses or guidelines pooled it, 320 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Campath, calcineurin inhibitor reduction, and chronic allograft nephropathy (the 3C Study) - results of a randomized controlled clinical trial.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2018
    Trial
  5. Trial
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  7. Review
  8. Article
  9. Article
  10. Review
  11. Article
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  15. Immunosuppressants/Immunomodulators and Malignancy.Journal of clinical medicine · 2025
    Review
  16. Article
  17. Article
  18. Article
  19. Article
  20. Review

41 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

24 authors at 14 institutions in 10 countries.

Greg A KnollOttawa Hospital Research Institute, Ottawa, ON, Canada University of Ottawa, Ottawa, ON, Canada gknoll@ottawahospital.on.ca.
Madzouka B KokoloOttawa Hospital Research Institute, Ottawa, ON, Canada.
Ranjeeta MallickOttawa Hospital Research Institute, Ottawa, ON, Canada.
Andrew BeckOttawa Hospital Research Institute, Ottawa, ON, Canada.
Chieny D BuenaventuraOttawa Hospital Research Institute, Ottawa, ON, Canada.
Robin DucharmeOttawa Hospital Research Institute, Ottawa, ON, Canada University of Ottawa, Ottawa, ON, Canada.
Rashad BarsoumCairo Kidney Center, Cairo University, Cairo, Egypt.
Corrado BernasconiLimites Medical Research, Vacallo Switzerland.
Tom D Blydt-HansenUniversity of Manitoba, Department of Pediatrics and Child's Health, Winnipeg, MB, Canada.
Henrik EkbergDepartment of Nephrology and Transplantation, Lund University, Malmo, Sweden.
Claudia R FelipeHospital do Rim e Hipertensao, Universidade Federal de Sao Paulo, Sao Paulo, Brazil.
John FirthDepartment of Renal Medicine, Addenbrooke's Hospital, Cambridge, UK.
Lorenzo GallonNorthwestern University, Feinberg School of Medicine, Chicago, IL, USA.
Marielle GelensMaastricht University Medical Centre, Maastricht, Netherlands.
Denis GlotzDepartment of Nephrology, Saint-Louis Hospital, Paris, France.
Jan GossmannDivision of Nephrology, Hospital of J.W. Goethe, Frankfurt, Germany.
Markus GubaDepartment of Surgery, University of Munich, Munich, Germany.
Ahmed Ali MorsyCairo Kidney Center, Cairo University, Cairo, Egypt.
Rebekka SalgoClinic of Dermatology, Venerology and Allergology, JW Goethe Clinic, University of Frankfurt, Germany.
Earnst H ScheuermannDivision of Nephrology, Hospital of J.W. Goethe, Frankfurt, Germany.
Helio Tedesco-SilvaHospital do Rim e Hipertensao, Universidade Federal de Sao Paulo, Sao Paulo, Brazil.
Stefan VitkoDepartment of Nephrology, Institutu Klinicke a Experimentalni Mediciny, Prague, Czech Republic.
Christopher WatsonUniversity of Cambridge, Department of Surgery, NIHR Cambridge Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK.
Dean A FergussonOttawa Hospital Research Institute, Ottawa, ON, Canada University of Ottawa, Ottawa, ON, Canada.
Ottawa Hospital · CAGoethe University Frankfurt · DEOttawa Hospital Research InstituteCairo University · EGAddenbrooke's Hospital · GBHôpital Saint-Louis · FRHospital do Rim e Hipertensão · BRInstitute of Clinical and Experimental Medicine · CZLund University · SEMaastricht University Medical Centre · NLNIHR Cambridge Biomedical Research CentreNorthwestern University · USUniversidade Federal de São Paulo · BRUniversity of Manitoba · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo examine risk of malignancy and death in patients with kidney transplant who receive the immunosuppressive drug sirolimus.

designSystematic review and meta-analysis of individual patient data. DATA SOURCES: Medline, Embase, and the Cochrane Central Register of Controlled Trials from inception to March 2013. ELIGIBILITY: Randomized controlled trials comparing immunosuppressive regimens with and without sirolimus in recipients of kidney or combined pancreatic and renal transplant for which the author was willing to provide individual patient level data. Two reviewers independently screened titles/abstracts and full text reports of potentially eligible trials to identify studies for inclusion. All eligible trials reported data on malignancy or survival.

resultsThe search yielded 2365 unique citations. Patient level data were available from 5876 patients from 21 randomized trials. Sirolimus was associated with a 40% reduction in the risk of malignancy (adjusted hazard ratio 0.60, 95% confidence interval 0.39 to 0.93) and a 56% reduction in the risk of non-melanoma skin cancer (0.44, 0.30 to 0.63) compared with controls. The most pronounced effect was seen in patients who converted to sirolimus from an established immunosuppressive regimen, resulting in a reduction in risk of malignancy (0.34, 0.28 to 0.41), non-melanoma skin cancer (0.32, 0.24 to 0.42), and other cancers (0.52, 0.38 to 0.69). Sirolimus was associated with an increased risk of death (1.43, 1.21 to 1.71) compared with controls.

conclusionsSirolimus was associated with a reduction in the risk of malignancy and non-melanoma skin cancer in transplant recipients. The benefit was most pronounced in patients who converted from an established immunosuppressive regimen to sirolimus. Given the risk of mortality, however, the use of this drug does not seem warranted for most patients with kidney transplant. Further research is needed to determine if different populations, such as those at high risk of cancer, might benefit from sirolimus.

Indexed as

Kidney TransplantationGraft RejectionHumansImmunosuppressive AgentsKidney Failure, ChronicPatient SelectionRandomized Controlled Trials as TopicRisk FactorsSirolimusSurvival AnalysisImmunosuppressive AgentsSirolimus

Identifiers

PMID25422259
PMCPMC4241732
OpenAlexW2137960096

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.