The role of tacrolimus in adult kidney transplantation: a review

The use of tacrolimus (FK506) in adult kidney-transplant recipients has bee n the subject of a number of single- and multi-center studies. This review article focuses on those studies in which tacrolimus was used either as res cue therapy in patients who developed refractory rejection on cyclosporine (CyA)-based regimens or as primary immunosuppression in adult renal-allogra ft recipients. Twenty-five prospective and retrospective studies conducted in the US, Japan and Europe, including single- and multi-center experiences , were identified in the medical literature. Of these studies, most show a 74-98% initial success rate for tacrolimus rescue therapy. Comparative stud ies reviewed herein demonstrate comparable patient- and graft-survival rate s between tacrolimus- and CyA-treated patients. Many studies have shown tha t rejection episodes occur with similar or lower frequency among patients t reated with tacrolimus than among those given CyA as primary immunosuppress ion. The major toxicities associated with tacrolimus are nephrotoxicity, ne urotoxicity and diabetogenicity. Results from several studies have also dem onstrated an association between these tacrolimus side effects and high who le-blood trough levels of tacrolimus. In many cases, a reduction in dosage can reverse these adverse effects. In summary, based on both single- and mu lti-center data, tacrolimus has been demonstrated to be efficacious when us ed for either primary immunosuppression or as rescue therapy for refractory acute rejection in adult renal-allograft recipients.