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.