Which calcineurin inhibitor is preferred in renal transplantation: Tacrolimus or cyclosporine?

Current Opinion in Nephrology and Hypertension

Volumn 8, Issue 6, 1999, Pages 669-674

  Vanrenterghem, Yves F Ch ^a  

^a UNIVERSITY HOSPITALS LEUVEN   (Belgium)

Author keywords

[No Author keywords available]

Indexed keywords

CYCLOSPORIN; CYCLOSPORIN A; LIPID; TACROLIMUS;

ARTICLE; DIABETES MELLITUS; DIABETOGENESIS; DRUG EFFICACY; GRAFT REJECTION; HUMAN; HYPERLIPIDEMIA; HYPERTENSION; KIDNEY TRANSPLANTATION; NEPHROTOXICITY; PRIORITY JOURNAL;

ARTERIOSCLEROSIS; CALCINEURIN; CYCLOSPORINE; DIABETES MELLITUS; GRAFT REJECTION; HUMANS; IMMUNOSUPPRESSIVE AGENTS; KIDNEY DISEASES; KIDNEY TRANSPLANTATION; TACROLIMUS; TIME FACTORS;

EID: 0033386956     PISSN: 10624821     EISSN: None     Source Type: Journal    
DOI: 10.1097/00041552-199911000-00003     Document Type: Article

References (35)

1. 1 Pirsch JD, Miller J, Deierhoi MH, Vincenti F, Filo RS. A comparison of tacrolimus (FK506) and cyclosporine for immunosuppression after cadaveric renal transplantation. Transplantation 1997; 63:977-983.
2. 2 Mayer AD, Dmitrewski J, Squifflet JP, Besse T, Grabensee B, Klein B, et al. Multicenter randomized trial comparing tacrolimus (FK506) and cyclosporine in the prevention of renal allograft rejection. Transplantation 1997; 64:436-443.
3. 3 Keown P, Niese D. Cyclosporine microemulsion increases drug exposure and reduces acute rejection without incremental toxicity in de novo renal transplantation. Kidney Int 1998; 54:938-944. This multicentre randomized trial compared the safety, tolerability and efficacy of the conventional cyclosporine formulation and the new cyclosporine microemulsion formulation in first and second kidney transplant recipients. A significantly lower incidence of acute rejections was seen in the microemulsion-treated patients.
4. 4 Morris-Stiff G, Singh J, Ostrowski K, Balaji V, Moore R, Darby C, et al. Prospective randomized study comparing FK506 (Prograf) and cyclosporine A (Neoral) as primary immunosuppression in cadaveric renal transplants at a single institution; interim report of the first 80 cases. Transplant Proc 1998; 30:1295-1296. This is an interim report of the first randomized study comparing the new microemulsion formulation of cyclosporine with tacrolimus in renal transplants in a single centre in the UK. Significantly more refractory rejections are seen in the Neoral group (n=40).
5. 5 Yang HC, Holman MJ, Langhoff E, Ulsch PJ, Dellock CA, Guota M, Ahsan N. Tacrolimus/'low dose' mycophenolate mofetil versus microemulsion cyclosporine/'low dose' mycophenolate mofetil after kidney transplantation: 1-year follow-up of a prospective, randomized clinical trial. Transplant Proc 1999; 31:1121-1124. This paper presents 1-year follow-up data of a single centre randomized trial that compared Neoral and tacrolimus in association with steroids and a low dose of MMF. Results were similar to those of the previous study [4••].
6. 6 Gonwa T, Johnson C, Ashan N, Halloran P, Stegall M, Hardy M, et al. Comparative trial of Prograf (tacrolimus) in combination with azathioprine or mycophenolate mofetil vs Neoral (cyclosporine) with mycophenolate mofetil after kidney transplantation [Abstract]. Transplantation 1999; 67:S239.
7. 7 Woodle ES, Thistlethwaite JR, Gordon JH, Laskow D, Deierhoi MH, Burdick J, et al. A multicenter trial of FK506 (tacrolimus) therapy in refractory acute renal allograft rejection. Transplantation 1996; 62:594-599.
8. 8 Jordan ML, Naraghi R, Shapiro R, Smith D, Vivas CA, Scantlebury VP, et al. Tacrolimus for rescue of refractory renal allograft rejection. Transplant Proc 1998; 30:1257-1260. This is a review of the single-centre Pittsburg experience in 169 renal transplant patients treated with tacrolimus for refractory rejection. Long-term success rate was 74%.
9. 9 Jiang H, Sakuma S, Fujii Y, Akiyama Y, Ogawa T, Tamura K, et al. Tacrolimus versus cyclosporin A: a comparative study on rat renal allograft survival. Transplant Int 1999; 12:92-99. This experimental study in rats showed that tacrolimus but not cyclosporine can successfully be used as antirejection therapy in ongoing renal allograft rejection.
10. 10 Vanrenterghem Y, Squifflet JP, Forsythe J, Heeman U, Bäckman L, Taube D, et al. Co-administration of tacrolimus and mycophenolate mofetil in cadaveric renal transplant recipients. Transplant Proc 1999; 30:1290-1291. This multicentre study analysed the efficacy and safety of the combination of tacrolimus and MMF in two doses (1 g and 2 g) after kidney transplantation.
11. 11 Miller J, for the FK506/MMF dose-ranging kidney transplant study group. Tacrolimus and mycophenolate mofetil in renal transplant recipients: one year results of a multicenter, randomized dose ranging trial. Transplant Proc 1999; 31:276-277. This study is similar to [10•]. In contrast to this study, only the 2 g dose was efficient.
12. 12 Zucker K, Rosen A, Nicholls A, Sharma A, Roth D, Esquenazi V, Miller J. A definitive effect of administration of tacrolimus on the pharmacokinetics of mycophenolate mofetil in renal transplant patients [Abstract]. Transplantation 1999; 67:S269.
13. 13 Lindholm A, Ohlman S, Albrechtsen D, Tufveson G, Persson H, Persson NH. The impact of acute rejection on long-term graft function and outcome in 1437 primary renal transplants treated by 3 cyclosporine regimens. Transplantation 1993; 56:307-315.
14. 14 Matas AJ, Gillingham KJ, Payne WD, Najarian JS. The impact of an acute rejection on long-term renal allograft survival. Transplantation 1994; 57:857-859.
15. 15 Vanrenterghem Y. Role of acute rejection in chronic rejection. Transplant Proc 1998; 30:1210-1211. This paper is a review of the recent literature with some personal data showing that the relation between acute rejection and chronic rejection, and late graft loss is more complex than originally thought.
16. 16 Gjertson DW, Cecka JM, Terasaki PI. The relative effects of FK506 and cyclosporine on short-and long-term kidney graft survival. Transplantation 1995; 60:1384-1388.
17. 17 Opelz G for the Collaborative Transplant Study. Immunosuppression with FK506 does not improve kidney graft survival. Transplant Proc 1999; 31:1147-1148. This short report of the CTS data shows that the outcome of renal transplant patients treated with tacrolimus is not different from that of those treated with cyclosporine. This analysis of the CTS registry can therefore not confirm the previously published results of the UCLA-UNOS registry [10•], which showed a significant increase of the graft half-life with tacrolimus.
18. 18 Mihatsch MJ, Kyo M, Morozumi K, Yamaguchi Y, Nickeleit V, Ryffel B. The side effects of ciclosporine A and tacrolimus. Clin Nephrol 1998; 49:356-363. This is a review of the literature and the author's own experience comparing the side-effect profiles of cyclosporine and tacrolimus. The authors concluded that the two calcineurin inhibitors are equally nephrotoxic.
19. 19 Solez K, Vincenti F, Filo RS. Histopathologic findings from 2-year protocol biopsies from a U.S. multicenter kidney transplant trial comparing tacrolimus versus cyclosporine. Transplantation 1998; 66:1736-1740. This is a detailed study of the protocol biopsies taken at 2 years after transplantation in about 50% of the patients randomized to either cyclosporine or tacrolimus within the American multicentre trial. A high incidence of chronic allograft nephropathy was seen, irrespective of the type of calcineurin inhibitor used. Nephrotoxicity and acute rejection were the most significant predictors of chronic allograft nephropathy at 2 years.
20. 20 Medina J, Cordier A, Wolf A. Cyclosporine A-induced contraction of isolated rat aortic smooth muscle cells. Life Sci 1997; 61:327-332.
21. 21 Hutchinson IV. An endothelin-transforming growth factor beta pathway in the nephrotoxicity of immunosuppressive drugs. Curr Opin Nephrol Hypertens 1998; 7:665-671. In this excellent overview the author formulates a pathogenetic mechanism linking acute and chronic calcineurin inhibitor-induced nephrotoxicity through a common endothelin-TGF pathway.
22. 22 Peters H, Noble NA, Border WA. Transforming growth factor-β in human glomerular injury. Curr Opin Nephrol Hypertens 1997; 6:389-393.
23. 23 Khanna AK, Cairns VR, Becker CG, Hosenpud JD. Transforming growth factor (TGF)-β mimics and anti-TGF β antibody abrogates the in vivo effects of cyclosporine. Transplantation 1999; 67:882-889. This experimental study in mice showed that the effects of cyclosporine can be modulated in vivo by manipulating TGF-β levels, suggesting that both the immunosuppressive and the toxic effects of cyclosporine may be mediated by TGF-β.
24. 24 Shin GT, Khanna A, Ding R, Sharma VK, Lagman M, Li B, Suthanthiran M. In vivo expression of transforming growth factor-β1 in humans. Transplantation 1998; 65:313-318.
25. 25 Hutchinson IV. The role of transforming growth factor-β in transplant rejection. Transplant Proc 1999 (in press). Interesting of the rote of TGF-β in acute and chronic rejection and the impact of cyclosporine and tacrolimus on TGF-β production.
26. 26 Mohamed MAS, Walmsley M, Robertson H, Kirby JA, Talbot D. The effect of cyclosporine A and tacrolimus on cultured human epithelial cells: the role of TGF-β. Transplant Proc 1999; 31:1173. This is a short report of a study on the proliferative effect of cyclosporine and of tacrolimus and the blocking of this effect by TGF-β antibody.
27. 27 Jensik SC, and the FK506 Kidney Transplant Study Group. Tacrolimus (FK506) in kidney transplantation: three-year survival results of the US multicenter, randomized comparative trial. Transplant Proc 1998; 30:1216-1218. This is a brief summary of the 3-year efficacy and safety results of the randomized American trial that compared cyclosporine with tacrolimus.
28. 28 Claesson K, Mayer AD, Squifflet JP, Grabensee B, Eigler FW, Behrend M, et al. Lipoprotein patterns in renal transplant patients: a comparison between FK506 and cyclosporine A patients. Transplant Proc 1998; 30:1292-1294. This analysis of the lipoprotein changes 1 year after transplantation shows lower cholesterol and LDL-cholesterol levels in tacrolimus-treated patients than in the cyclosporine-treated patients.
29. 29 McCune TR, Thacker LR, Peters TG, Mulloy L, Rohr MS, Adams PA, et al. Effects of tacrolimus on hyperlipidemia after successful renal transplantation. Transplantation 1998; 65:87-92.
30. 30 Friemann S, Feuring E, Padberg W, Ernst W. Improvement of nephrotoxicity, hypertension, and lipid metabolism after conversion of kidney transplant recipients from cyclosporine to tacrolimus. Transplant Proc 1998; 30:1240-1242. This is a single centre analysis in 40 patients of renal function, lipid metabolism and blood pressure before and after conversion from cyclosporine to tacrolimus.
31. 31 Radermacher J, Meiners M, Bramlage V, Kliem V, Berhrend M, Schlitt HJ, et al. Pronounced renal vasoconstriction and systemic hypertension in renal transplant patients treated with cyclosporin A versus FK 506. Transplant Int 1998; 11:3-11.
32. 32 Weir MR, Fink JC. Risk for posttransplant diabetes mellitus with current immunosuppressive medications. Am J Kidney Dis 1999; 34:1-13. This is an excellent in-depth overview of the risks for developing diabetes mellitus after organ transplantation under the current immunosuppressive medications. Corticosteroids, cyclosporine and tacrolimus are responsible for the occurrence of post-transplant diabetes mellitus.
33. 33 Miles AM, Sumrani N, Horowitz R, Homel P, Maursky V, Markell MS, et al. Diabetes mellitus after renal transplantation. As deleterious as non-transplant-associated diabetes. Transplantation 1998; 65:380-384.
34. 34 Neylan JF, for the FK506 kidney transplant study group. Racial differences in renal transplantation after immunosuppression with tacrolimus versus cyclosporine. Transplantation 1998; 65:515-523.
35. 35 Van Hooff JP, van Duijnhoven EM, Christiaans MHL. Tacrolimus and glucose metabolism. Transplant Proc 1999 (in press). This single centre study compared glucose metabolism during the first posttransplant months in 12 tacrolimus-treated and 11 cyclosporine-treated patients. No differences were seen.