This paper is based upon a Cochrane report: Haddad EM, McAlister VC, Renouf E, Malthaner R, Kjaer MS, Gluud LL. Cyclosporin versus tacrolimus for liver transplanted patients. In: Cochrane Database of Systematic Reviews, 2006. It was presented to the Joint International Congress of ILTS, ELITA and LICAGE at Milan, Italy in May 2006.
Cyclosporin versus Tacrolimus as Primary Immunosuppressant After Liver Transplantation: A Meta-Analysis
Article first published online: 8 MAY 2006
American Journal of Transplantation
Volume 6, Issue 7, pages 1578–1585, July 2006
How to Cite
McAlister, V. C., Haddad, E., Renouf, E., Malthaner, R. A., Kjaer, M. S. and Gluud, L. L. (2006), Cyclosporin versus Tacrolimus as Primary Immunosuppressant After Liver Transplantation: A Meta-Analysis. American Journal of Transplantation, 6: 1578–1585. doi: 10.1111/j.1600-6143.2006.01360.x
Conflict of interest
No funding was received for this study. Companies that make cyclosporin and tacrolimus and the principal investigators of each study were contacted in the course of the review. Vivian McAlister took part in clinical trials sponsored by each company and received, more than 10 years ago, laboratory grants-in-aid from each company.
- Issue published online: 8 MAY 2006
- Article first published online: 8 MAY 2006
- Received 4 January 2006, revised 19 February 2006 and accepted for publication 20 March 2006
- liver transplantation;
A systematic review of randomized clinical trials (RCT) was undertaken to evaluate the beneficial and harmful effects of immunosuppression with cyclosporin versus tacrolimus for liver transplanted patients. MEDLINE, EMBASE, Cochrane Central and Hepato-Biliary Group Controlled Trials Registers were searched. Using fixed and random effects model, relative risk (RR), values <1 favoring tacrolimus, with 95% confidence intervals (CI) were calculated. Of 717 potentially relevant references, 16 RCTs were eligible for inclusion. Mortality and graft loss at 1 year were significantly reduced in tacrolimus-treated recipients (Death: RR 0.85, 95% CI 0.73–0.99; graft loss: RR 0.73, 95% CI 0.61–0.86). Tacrolimus reduced the number of recipients with acute rejection (RR 0.81, 95% CI 0.75–0.88) and steroid-resistant rejection (RR 0.54, 95% CI 0.47–0.74) in the first year. Lymphoproliferative disorder or dialysis rates were not different but more de novo diabetes (RR 1.38, 95% CI 1.01–1.86) occurred with tacrolimus. More patients stopped cyclosporin than tacrolimus (RR 0.57, 95% CI 0.49–0.66). Treating 100 recipients with tacrolimus instead of cyclosporin would avoid rejection and steroid-resistant rejection in nine and seven patients respectively, graft loss and death in five and two patients respectively, but four additional patients would develop diabetes after liver transplantation.