Tacrolimus Improves Renal Transplant Outcome

Studies show that tacrolimus produces a better outcome as an immunosuppressant than cyclosporine following renal tranplantation. The studies were presented at the XVIII International Congress of the Transplantation Society in Rome by investigators from the Rome University Hospital, Leuven University Hospital (Belgium), and Cincinnati University Hospital (USA).

A five-year comparison of tacrolimus vs. the old formulation of cyclosporine showed significant differences for graft survival in favor of tacrolimus (64.1% vs. 54.3%). A six-month comparison of tacrolimus and cyclosporine in microemulsion confirms the superior efficacy of tacrolimus for the prophylaxis of rejection (19.6% vs, 37.3%). Also, tacrolimus therapy was found to be associated with less hypertension and hyperlipidemia and a notable tendency toward better kidney function.

Although graft function is the goal of transplantation, the main cause for graft loss after the first year is patient death with a functioning graft (56%), compared to chronic graft dysfunction (21%), noncompliance (13%), and other reasons. Investigators noted that 40% of these deaths have cardiovascular problems as an underlying cause. Most of the immunosuppressants used tend to exacerbate the problem, since they have a detrimental effect on lipid metabolism, blood pressure, and glucose metabolism. Therefore, the key to long-term success may be to tailor the immunosuppressive regimen in order to reduce cardiovascular risk factors while providing an adequate level of rejection prophylaxis.

The most acceptable balance between rejection rate, graft function, post-transplant diabetes mellitus, hypertension, and lipid profile is achieved with Prograf (tacrolimus) based therapy and steroid withdrawal, said chairperson Prof. M. Roy First, Cincinnati University Hospital. Prograf is the product of Fujisawa Pharmaceutical Co., Ltd. (Japan).