BMJ 1999;318:1104-1107 ( 24 April )

Papers

Tacrolimus versus cyclosporin for immunosuppression in renal transplantation: meta-analysis of randomised trials

Greg A Knoll, nephrologist,  Robert C Bell, nephrologist. 

Division of Nephrology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario K1H 8L6, Canada

Correspondence to: Dr Knoll gknoll{at}ogh.on.ca

Objective: To compare tacrolimus with cyclosporin for immunosuppression in renal transplantation.
Design: Meta-analysis of randomised trials of two treatments after kidney transplantation.
Identification: Four studies involving 1037 patients. Trials were included if they were randomised, the intervention group received tacrolimus, the control group received cyclosporin, the patients were followed for a minimum of 12 months, and patient survival, graft survival, incidence of acute rejection, need for antilymphocyte treatment, or the prevalence of diabetes mellitus after transplant was reported.
Main outcome measures: Pooled estimates of patient mortality, allograft loss, and episodes of acute rejection 1 year after transplantation.
Results: The odds ratio for loss of allograft with tacrolimus compared with cyclosporin was 0.95 (95% confidence interval 0.65 to 1.40). The odds ratio for mortality with tacrolimus was 1.07 (0.47 to 2.48). Treatment with tacrolimus was associated with a reduction in episodes of acute rejection (0.52; 0.36 to 0.75), a reduction in the use of antilymphocyte antibodies to treat rejection (0.37; 0.25 to 0.56), and an increased prevalence of diabetes mellitus after transplantation (5.03; 2.04 to 12.36) compared with treatment with cyclosporin.
Conclusions: After renal transplantation, immunosuppression with tacrolimus results in a significant reduction in acute rejection compared with cyclosporin. Follow up studies of high methodological quality are needed to determine whether tacrolimus improves long term renal graft survival.

Key messages Cyclosporin is currently the most widely used and important immunosuppressive agent in renal transplantation The use of tacrolimus, an alternative immunosuppressant to cyclosporin, has increased in recent years Treatment with tacrolimus resulted in a significant reduction in episodes of acute rejection compared with cyclosporin Follow up studies are required to see if tacrolimus improves long term survival of kidney grafts

---

© BMJ 1999
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Articles

Tacrolimus versus ciclosporin as primary immunosuppression for kidney transplant recipients: meta-analysis and meta-regression of randomised trial data

Angela C Webster, Rebecca C Woodroffe, Rod S Taylor, Jeremy R Chapman, and Jonathan C Craig
BMJ 2005 331: 810. [Abstract] [Full Text] [PDF]

Immunosuppression in renal transplantation

G Morris-Stiff, A Khan, I Quiroga, R Baboo, W A Jurewicz, Peter A Andrews, Andrew J Krentz, Greg Knoll, and Robert Bell
BMJ 1999 319: 1136. [Extract] [Full Text]

Managing chronic disease
BMJ 1999 318: 0. [Full Text] [PDF]

Still no final decision on best immunosuppressant after kidney transplantation
BMJ 1999 318: 0. [Full Text]

This article has been cited by other articles:

• Johnston, O., Rose, C. L., Webster, A. C., Gill, J. S. (2008). Sirolimus Is Associated with New-Onset Diabetes in Kidney Transplant Recipients. J. Am. Soc. Nephrol. 19: 1411-1418 [Full text]  
• Chan, H. W., Cheung, C. Y., Liu, Y. L., Chan, Y. H., Wong, H. S., Chak, W. L., Choi, K. S., Chau, K. F., Li, C. S. (2008). Prevalence of abnormal glucose metabolism in Chinese renal transplant recipients: a single centre study. Nephrol Dial Transplant 0: gfn246v1-gfn246 [Abstract] [Full text]  
• Ballarin, J., Poveda, R., Ara, J., Perez, L., Calero, F., Grinyo, J. M., Romero, R. (2007). Treatment of idiopathic membranous nephropathy with the combination of steroids, tacrolimus and mycophenolate mofetil: results of a pilot study. Nephrol Dial Transplant 22: 3196-3201 [Abstract] [Full text]  
• Joseph, A, Raj, D, Shanmuganathan, V, Powell, R J, Dua, H S (2007). Tacrolimus immunosuppression in high-risk corneal grafts. Br. J. Ophthalmol. 91: 51-55 [Abstract] [Full text]  
• Tang, S. C.-W., Chan, K. W., Tang, C. S.-O., Lam, M. F., Leung, C. Y., Tse, K. C., Li, C. S., Ho, Y. W., Tong, M. K.-L., Lai, K. N., Chan, T. M., for the Hong Kong Nephrology Study Group, (2006). Conversion of ciclosporin A to tacrolimus in kidney transplant recipients with chronic allograft nephropathy. Nephrol Dial Transplant 21: 3243-3251 [Abstract] [Full text]  
• Webster, A. C, Woodroffe, R. C, Taylor, R. S, Chapman, J. R, Craig, J. C (2005). Tacrolimus versus ciclosporin as primary immunosuppression for kidney transplant recipients: meta-analysis and meta-regression of randomised trial data. BMJ 331: 810- [Abstract] [Full text]  
• Lindenfeld, J., Page, R. L. II, Zolty, R., Shakar, S. F., Levi, M., Lowes, B., Wolfel, E. E., Miller, G. G. (2005). Drug Therapy in the Heart Transplant Recipient: Part III: Common Medical Problems. Circulation 111: 113-117 [Full text]  
• Davidson, J. A, Wilkinson, A. (2004). New-Onset Diabetes After Transplantation 2003 International Consensus Guidelines: An endocrinologist's view. Diabetes Care 27: 805-812 [Full text]  
• Knoop, C., Haverich, A., Fischer, S. (2004). Immunosuppressive therapy after human lung transplantation. Eur Respir J 23: 159-171 [Abstract] [Full text]  
• Kaplan, B., Schold, J. D., Meier-Kriesche, H.-U. (2003). Long-Term Graft Survival with Neoral and Tacrolimus: A Paired Kidney Analysis. J. Am. Soc. Nephrol. 14: 2980-2984 [Abstract] [Full text]  
• Adu, D., Cockwell, P., Ives, N. J, Shaw, J., Wheatley, K. (2003). Interleukin-2 receptor monoclonal antibodies in renal transplantation: meta-analysis of randomised trials. BMJ 326: 789-789 [Abstract] [Full text]  
• Cho, Y. M., Park, K. S., Jung, H. S., Jeon, H. J., Ahn, C., Ha, J., Kim, S. J., Rhee, B. D., Kim, S. Y., Lee, H. K. (2003). High Incidence of Tacrolimus-Associated Posttransplantation Diabetes in the Korean Renal Allograft Recipients According to American Diabetes Association Criteria. Diabetes Care 26: 1123-1128 [Abstract] [Full text]  
• Andrews, P. A (2002). Recent developments: Renal transplantation. BMJ 324: 530-534 [Full text]  
• van Duijnhoven, E. M., Christiaans, M. H. L., Boots, J. M. M., Nieman, F. H. M., Wolffenbuttel, B. H. R., van Hooff, J. P. (2002). Glucose Metabolism in the First 3 Years after Renal Transplantation in Patients Receiving Tacrolimus versus Cyclosporine-Based Immunosuppression. J. Am. Soc. Nephrol. 13: 213-220 [Abstract] [Full text]  
• Boots, J. M. M., van Duijnhoven, E. M., Christiaans, M. H. L., Wolffenbuttel, B. H. R., van Hooff, J. P. (2002). Glucose Metabolism in Renal Transplant Recipients on Tacrolimus: The Effect of Steroid Withdrawal and Tacrolimus Trough Level Reduction. J. Am. Soc. Nephrol. 13: 221-227 [Abstract] [Full text]  
• Staatz, C., Taylor, P., Tett, S. (2001). Low tacrolimus concentrations and increased risk of early acute rejection in adult renal transplantation. Nephrol Dial Transplant 16: 1905-1909 [Abstract] [Full text]  
• Hjelmesath, J., Hartmann, A., Kofstad, J., Egeland, T., Stenstrom, J., Fauchald, P. (2001). Tapering off prednisolone and cyclosporin the first year after renal transplantation: the effect on glucose tolerance. Nephrol Dial Transplant 16: 829-835 [Abstract] [Full text]  
• DUIJNHOVEN, E. M. V., BOOTS, J. M. M., CHRISTIAANS, M. H. L., WOLFFENBUTTEL, B. H. R., HOOFF, J. P. V. (2001). Influence of Tacrolimus on Glucose Metabolism before and after Renal Transplantation: A Prospective Study. J. Am. Soc. Nephrol. 12: 583-588 [Abstract] [Full text]  
• KASISKE, B. L., VAZQUEZ, M. A., HARMON, W. E., BROWN, R. S., DANOVITCH, G. M., GASTON, R. S., ROTH, D., SCANDLING, J. D. JR., SINGER, G. G. (2000). Recommendations for the Outpatient Surveillance of Renal Transplant Recipients. J. Am. Soc. Nephrol. 11: S1-S86 [Abstract] [Full text]  
• Morris-Stiff, G, Khan, A, Quiroga, I, Baboo, R, Jurewicz, W A, Andrews, P. A, Krentz, A. J, Knoll, G., Bell, R. (1999). Immunosuppression in renal transplantation. BMJ 319: 1136-1136 [Full text]  

Rapid Responses:

Read all Rapid Responses

Is the conclusion valid?

G Morris-Stiff
bmj.com, 24 May 1999 [Full text]

Meta-analysis of tacrolimus vs cyclosporin

Peter A Andrews
bmj.com, 17 Jun 1999 [Full text]