Comparison of tacrolimus with a cyclosporine microemulsion for immunosuppressive therapy in kidney transplantation

Objective: To compare the efficacy and side effects of a cyclosporine microemulsion and tacrolimus in kidney transplantation immunosuppressive therapy.Materials and methods: Between March 2003 and June 2005, the patients who had undergone kidney tx surgery and who were administered either basiliximab, a cyclosporine microemulsion, mycophenolate mofetil and prednisolone or basiliximab, tacrolimus, mycophenolate mofetil and prednisolone for base-line immunosuppressive therapy were recruited to our study. We evaluated the results after an 18-month follow-up period. The donors were called back weekly for a follow-up in the first month, fortnightly in the second month and then monthly for 18 months after discharge. A total of 41 patients were included. The demographics, acute rejection, cardiovascular and metabolic side effects, graft function, infections, hirsutism, gingival hyperplasia, cosmetic side effects, nephrotoxicity, drug changes and the survival of the patients were evaluated.Results: There were no significant differences among the patients with regard to age, sex, donor type, dialysis periods, preoperative and postoperative systolic blood pressures, creatinine levels, hepatotoxicity, nephrotoxicity, the occurrence of diabetes mellitus and the incidence of infection. The duration of hospitalization was prolonged in the cyclosporin A group. Acute rejection emerged in 5 patients (23.8%) in the tacrolimus group and in 4 patients (20%) in the cyclosporin A group. In the cyclosporin A group, the cholesterol and triglyceride levels were significantly higher than the tacrolimus group. The cosmetic side effects (gingival hyperplasia and hirsutism) as a reason for a change in medication were only observed in the cyclosporin A group, not in the tacrolimus group. A medication change was made in 8 patients in the cyclosporin A group and in 1 patient in the tacrolimus group. No death was observed in either group. Graft loss was observed in only 1 patient in the cyclosporin A group.Conclusion: Regarding the cosmetic side effects and hyperlipidemia, tacrolimus was found to be superior to cyclosporine A. Where hyperlipidemia is considered to be a risk factor for cardiovascular disease, tacrolimus use should be considered a more acceptable treatment course. However, the immunosuppressive regimen should be individually evaluated.