Tacrolimus versus cyclosporin for immunosuppression in renal transplantation: meta-analysis of randomised trials
BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7191.1104 (Published 24 April 1999) Cite this as: BMJ 1999;318:1104
- Greg A Knoll (gknoll{at}ogh.on.ca), nephrologist,
- Robert C Bell, nephrologist
- Division of Nephrology, Department of Medicine,The Ottawa Hospital, University of Ottawa, Ottawa, Ontario K1H 8L6, Canada
- Correspondence to: Dr Knoll
- Accepted 10 February 1999
Abstract
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.
Footnotes
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Funding None.
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Conflict of interest Competing interests: GK has been reimbursed by Sangstat to attend a meeting on induction therapy in transplantation. RB has spoken at a meeting sponsored by Fujisawa (manufacturers of Prograf (tacrolimus)) but did not receive any financial support or honorarium.