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

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.