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

Objective To compare tacrolimus with cyclosporin for immunosuppression in r enal transplantation. Design Meta-analysis of randomised trials of two treatments after kidney tr ansplantation. Identification Four studies involving 1037 patients. Trials were included i f they were randomised, the intervention group received tacrolimus, the con trol group received cyclosporin, the patients were followed for a minimum o f 12 months, and patient survival, graft survival, incidence of acute rejec tion, need for antilymphocyte treatment, or the prevalence of diabetes mell itus after transplant was reported. Main outcome measures Pooled estimates of patient mortality; allograft loss , and episodes of acute rejection 1) ear 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 tacr olimus 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 tre at 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 treatmen t with cyclosporin. Conclusions After renal transplantation, immunosuppression with tacrolimus results in a significant reduction in acute rejection compared with cyclosp orin. Follow up studies of high methodological quality are needed to determ ine wether tacrolimus improves long term renal graft survival.