Eleven studies (n=119,330 patients) were included in the review. The quality of the studies was not reported.
The use of aprotinin was associated with a significant increased risk of renal dysfunction (RR 1.42, 95% CI 1.13 to 1.79; 10 studies) and long-term death (HR 1.22, 95% CI 1.08 to 1.39; three studies). The use of aprotinin was associated with a non-significant increased risk of needing dialysis (RR 1.17, 95% CI 0.99 to 1.38; five studies) and short-term death (RR 1.16, 95% CI 0.84 to 1.58; six studies).
There was evidence of significant heterogeneity for renal dysfunction (I2=73%) and for short-term death (I2=72%). No significant heterogeneity was found for the need for dialysis or long-term death.
Results of the stratified analyses produced similar effect estimates. Meta-regression analyses found duration of cardiopulmonary bypass time to be a significant source of heterogeneity for renal dysfunction - for every ten minutes increase in cardiopulmonary bypass time, there was an associated 29% increased risk of renal dysfunction.
Sensitivity analyses produced altered results only for the need for dialysis outcome; this became statistically significant when one large study was excluded and when transfusion-adjusted effect estimate of another study was replaced with the non-adjusted results. It was reported that publication bias was possibly present for renal dysfunction, as determined by the funnel plot and the Egger test (p=0.04); and need for dialysis as determined by the Begg test (p=0.05).