BACKGROUND: Deterioration after ICU discharge may lead to readmission or even death.Interventions (e.g. critical care transition programs) have been developed to improve the clinical handover between the ICU and ward.We conducted a systematic review with meta-analysis and trial sequential analysis (TSA) according to Cochrane Handbook andGrading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology to assessthe impact of these interventionson readmission and death (PROSPERO, no CRD42019121746). METHODS: We searched PubMed/MEDLINE, CINAHL, AMED, PsycINFO and the Cochrane Central Register for Controlled Trialsfrom inception until January 2019. We included historically controlled studies that evaluated critical care transition programs in adults discharged from the ICU. Readmission and in-hospital mortality were the primary outcomes. Risk of bias, publications bias and the quality of evidence were assessed with the ROBINS-Itool, funnel plot and GRADE, respectively. RESULTS: Fifteenobservationalstudies were included (11 in meta-analysis).All studies had at least serious risk of bias. ICU discharge within a critical care transition program modestly reduced the risk of readmission (RR 0.78; 95% CI: 0.64 to 0.96; TSA-adjusted 95% CI: 0.59 to 1.03) but not in-hospital mortality(RR 0.82; 95% CI: 0.64 to 1.06; TSA-adjusted 95% CI: 0.49 to 1.37). There was substantial heterogeneity among studies. TSA indicated lack of firm evidence. The GRADE quality of evidence on outcomes was very low. CONCLUSIONS: We found no clear benefit in terms of reducing risk of readmission or death after ICU discharge,however with overall very low certainty of evidence.