Serious adverse events were defined according to the International Conference on Harmonisation (ICH) Guidelines for Good Clinical Practice as any untoward medical occurrence that at any dose resulted in death, was lifethreatening, required inpatient hospitalisation or prolongation of existing hospitalisation, or resulted in persistent or significant disability or incapacity, or was a congenital anomaly/birth defect, or any medical event that might have jeopardised the patient, or required intervention to prevent it (ICHGCP 1997). International Clinical Trials Registry Platform (ICTRP) on 30 September 2013 together with reference checking, citation searching, contact with trial authors and pharmaceutical companies to identify additional trials. == Selection criteria == We included all randomised clinical trials assessing immunosuppression with Tcell specific antibody induction versus Polyphyllin B Rabbit polyclonal to ISLR corticosteroid induction in liver transplant recipients. Our inclusion criteria stated that participants within each included trial should have received the same maintenance immunosuppressive therapy. == Data collection and analysis == We used RevMan for statistical analysis of dichotomous data with risk ratio (RR) and of continuous data with mean difference (MD), both with 95% confidence intervals (CIs). We assessed risk of systematic errors (bias) using bias risk domains with definitions. We used trial sequential analysis to control for random errors (play of chance). == Main results == We included 10 randomised trials with a total of 1589 liver transplant recipients, which studied the Polyphyllin B use of Tcell specific antibody induction versus corticosteroid induction. All trials were with high risk of bias. We compared any kind of Tcell specific antibody induction versus corticosteroid induction in 10 trials with 1589 participants, including interleukin2 receptor antagonist induction versus corticosteroid induction in nine trials with 1470 participants, and polyclonal Tcell specific antibody induction versus corticosteroid induction in one trial with 119 participants. Our analyses showed no significant differences regarding mortality (RR 1.01, 95% CI 0.72 to 1 1.43), graft loss (RR 1.12, 95% CI 0.82 to 1 1.53) and acute rejection (RR 0.84, 95% CI 0.70 to 1 1.00), infection (RR 0.96, 95% CI 0.85 to 1 1.09), hepatitis C virus recurrence (RR 0.89, 95% CI 0.79 to 1 1.00), malignancy (RR 0.59, 95% CI 0.13 to 2.73), and posttransplantation lymphoproliferative disorder (RR 1.00, 95% CI 0.07 to 15.38) when any kind of Tcell specific antibody induction was compared with corticosteroid induction (all lowquality evidence). Cytomegalovirus infection was less frequent in patients receiving any kind of Tcell specific antibody induction compared with corticosteroid induction (RR 0.50, 95% CI 0.33 to 0.75; lowquality evidence). This was also observed when interleukin2 receptor antagonist induction was compared with corticosteroid induction (RR 0.55, 95% CI 0.37 to 0.83; lowquality evidence), and when polyclonal Tcell specific antibody induction was compared with corticosteroid induction (RR 0.21, 95% CI 0.06 to 0.70; lowquality evidence). However, when trial sequential analysis regarding cytomegalovirus infection was applied, the required information size was not reached. Furthermore, diabetes mellitus occurred less frequently when Tcell specific antibody induction was compared with corticosteroid induction (RR 0.45, 95% CI 0.34 to 0.60; lowquality evidence), when interleukin2 receptor antagonist induction was compared with corticosteroid induction (RR 0.45, 95% CI 0.35 to 0.61; lowquality evidence), and when polyclonal Tcell specific antibody induction was compared with corticosteroid induction (RR 0.12, 95% CI 0.02 to 0.95; lowquality evidence). When trial sequential analysis was applied, the trial sequential monitoring boundary for benefit was crossed. We found no subgroup differences for type of interleukin2 receptor antagonist (basiliximab versus daclizumab). Four trials reported on adverse events. However, no differences between trial groups were noted. Limited data were available for metaanalysis on drugspecific adverse events such as haematological adverse events for antithymocyte globulin. No data were Polyphyllin B available on quality of life. == Authors’ conclusions == Because of the low quality of the evidence, the effects of Tcell antibody induction remain uncertain. Tcell specific antibody induction seems to reduce diabetes mellitus and may reduce cytomegalovirus infection when compared with corticosteroid induction. No other clear benefits or harms were associated with the use of Tcell specific antibody induction compared with corticosteroid induction. For some analyses, the number of trials investigating the use of Tcell specific antibody induction after liver transplantation is small, and the numbers of participants and outcomes in these randomised trials are limited. Furthermore, the included trials are heterogeneous in nature Polyphyllin B and have applied different types of Tcell specific antibody induction therapy. All trials were at high risk of bias. Hence, additional randomised clinical trials are needed to assess the benefits and harms of Tcell specific antibody induction compared with corticosteroid induction for liver transplant recipients. Such trials ought to be conducted with low risks of systematic error and of random error. == Plain language summary == Antibody induction therapy compared with corticosteroids for induction of immunosuppression after liver transplantation BackgroundHistorically, corticosteroids have been the backbone of immunosuppression after liver transplantation, and corticosteroids are typically started immediately before or during transplantation. However, the use of corticosteroids is associated with several complications such as infection,.