Tacrolimus vs Neoral in renal and renal/pancreas transplantation

In a retrospective analysis we compared the outcome of a group of 63 kidney or kidney/pancreas transplant recipients who were transplanted between Jun e 1994 and February 1997 and received either tacrolimus (FK, n = 22) or Neo ral (NEO, n = 41) as part of a triple immunosuppressive protocol. Ten patie nts in the NEO group had recurrent rejection episodes between 1 and 8 month s post-transplant and were converted to FK. CellCept was the secondary immu nosuppressive agent in about half the FK, three-quarters of the NEO, and in all but one in the conversion (CON) groups. Patients in all groups were on prednisone in equal amounts. Mean duration of follow-up for FK, NEO and CO N groups was 32, 19 and 13 months, respectively. One-yr patient and graft s urvival was 100% in all groups. At 2 yr, graft survival was 95, 96 and 100% in FK, NEO and CON groups, respectively. Acute rejection at 1 yr was twice as high in the NEO group as the FK group. There were no rejection episodes among the FK patients who also received CellCept. The mean current serum c reatinines (mg%) were: FK = 1.6, NEO = 1.8, CON = 1.9. Recurrent infection was more common with FK (8/22) than NEO (1/31) (p = 0.023). Our experience suggests there is less rejection but more infection in recipients treated w ith FK compared to NEO. In patients with recurrent rejection, conversion fr om NEO to FK stabilizes renal function and minimizes subsequent rejection e pisodes.