Improving long-term renal transplant outcomes with tacrolimus: speculation vs evidence.

Achieving long-term graft survival and optimal patient health are ultimate clinical goals in renal transplantation. Many factors negatively impact long-term transplant outcomes, including graft rejection, renal dysfunction and increased cardiovascular burden. Additionally, glucose metabolism disturbance, also a cardiovascular risk factor, influences morbidity and mortality. As such, careful consideration of the immunosuppressive strategy and its impact on these factors is critical to optimizing outcomes. Large-scale clinical trials and registry studies conducted over the past decade have demonstrated tacrolimus to be a cornerstone immunosuppressant in renal transplantation. Compared with ciclosporin treatment, tacrolimus has been shown to be associated with decreased acute and chronic rejection, improved renal function over the long term post-transplant, as evidenced by lower serum creatinine concentrations and a slower decline in the glomerular filtration rate, and a superior cardiovascular risk profile, as demonstrated by lower incidences of hyperlipidaemia and hypertension. The incidence of new-onset diabetes in patients receiving tacrolimus is low due to continued refinement of tacrolimus-based regimens and a better understanding of the effects of tacrolimus on metabolic parameters. Together, these findings may translate into improved long-term transplant outcomes with tacrolimus-based immunosuppression. In fact, long-term follow-up results from multicentre trials plus data from registry analyses are already documenting improved survival with this cornerstone immunosuppressant.