Cyclosporin and tacrolimus in clinical transplantation - A comparative review

Major advances have been made in the field of organ transplantation in the last 2 decades. In the early 1980s, cyclosporin made a significant impact in improving graft and patient survival following transplantation. However, acute and chronic rejection still remained a principal concern. The introduction of tacrolimus has seen a significant reduction in the incidence and severity of rejections for heart, lung and liver transplantation. Its ability to control steroid-resistant rejection occurring on cyclosporin-based immunosuppression has been remarkable for kidney, liver, heart, lung and pancreatic transplantation. It also has shown the ability to control chronic rejection in liver transplant recipients in up to 70% of cases. The need for concomitant use of corticosteroids has been significantly lower with tacrolimus. The ability of tacrolimus to be absorbed independently of bile has significantly reduced the need for prolonged intravenous administration in liver transplant recipients and has contributed to the success of small bowel transplantation. Both drugs are nephrotoxic and neurotoxic, effects which are reversible in most instances. Both drugs have a diabetogenic effect to an almost equal extent. Hypertension is more common with cyclosporin, while hyperkalaemia is more common with tacrolimus. Higher levels of cholesterol and low density lipoprotein have been observed with cyclosporin compared with tacrolimus. The hirsutism and gingival hyperplasia that occur with cyclosporin are not observed with tacrolimus.