Impact of tacrolimus versus cyclosporine on one-year renal transplant outcomes: A single-centre retrospective cohort study

Abstract

Background: Calcineurin inhibitors are the cornerstone of maintenance immunosuppression after kidney transplant. While studies on predominantly Caucasian populations recommend tacrolimus over cyclosporine, the effects on Singapore’s local population remain unclear. Objectives: This study aimed to compare the impact of tacrolimus against cyclosporine on post-transplant outcomes in our local kidney transplant population. Methods: A single-centre retrospective chart review was conducted on ABO- and human leucocyte antigen (HLA)-compatible kidney transplantations between 1 January 2011 and 15 August 2018. Patients who received basiliximab induction, prednisolone, mycophenolate and either tacrolimus or cyclosporine were included and followed up for at least one year. Recipients of transplantations at other institutions or other immunosuppressive regimens were excluded. Patient and graft outcomes and adverse effects were collected. Results: Overall, 120 patients on tacrolimus and 49 on cyclosporine were included. Patients on tacrolimus were older. This group had more deceased donor transplants, a higher proportion with donor-specific antibodies (DSAs) present and more HLA mismatches. There were no differences in patient and graft survival, graft function and acute rejections at one year, despite adjusting for age, transplant type, presence of DSAs and total HLA mismatches. The tacrolimus group had more infectious admissions (odds ratio=0.27, 95% confidence interval 0.098–0.73, p=0.01) after adjusting for age, transplant type, HLA mismatches, presence of DSAs and acute rejections, with increased severity and more opportunistic infections. More patients on cyclosporine required a change to alternative immunosuppressants (p=0.003). Conclusion: Our study demonstrated comparable short-term post-transplant outcomes between cyclosporine and tacrolimus. Tacrolimus appears more tolerable but may be associated with infection risks.

Human cytomegalovirus‐related gastrointestinal disease after kidney transplantation: A systematic review

“…The association between chronic exposure to tacrolimus or MMF and post‐transplant hCMV infection has been extensively investigated. Both drugs may increase the risk of hCMV tissue‐invasive disease compared to cyclosporine or azathioprine, respectively 92–95 . As no direct comparison can be made between patients with or without hCMV‐GID who receive different immunosuppressive schemes, the value of our findings in confirming this theory is limited.…”

“…Both drugs may increase the risk of hCMV tissue-invasive disease compared to cyclosporine or azathioprine, respectively. [92][93][94][95] As no direct comparison can be made between patients with or without hCMV-GID who receive different immunosuppressive schemes, the value of our findings in confirming this theory is limited. mTORi may reduce the incidence and severity of various post-transplant viral infections, including hCMV.…”

Prenatal Exposition to Different Immunosuppressive Protocols Results in Vacuolar Degeneration of Hepatocytes

“…This clearly indicates that an ID protocol based on tacrolimus seems to be more harmful in aspect of VD, in comparison to a regimen based on CsA. According to Ong et al [37], tacrolimus is considered to be almost 100 times stronger than CsA. On the other hand, both the immature fetal liver and placenta can metabolise drugs.…”

“…Mycophenolate mofetil belongs to D group, described as confirmed risk for human fetus. According to the literature, comparing the two used CNIs, TAC is more toxic than CsA [37]. Regarding the comparison between MMF and EVE, they exhibit a similar strength of action [38].…”

Prescribing Pattern and Safety of Immunosuppressants in Renal Transplant Patients: An Observational Study

“…Ong et al [ 11 ] conducted a single-center retrospective study comparing the impact of tacrolimus against cyclosporine on post-transplant outcomes in the kidney transplant population. In this study, they found comparable short-term post-transplant outcomes between cyclosporine and tacrolimus.…”