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Single-center experience with tacrolimus versus cyclosporine-Neoral in renal transplant recipients

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Abstract.

Tacrolimus has proven to be superior to cyclosporine-Sandimmune with regard to the prevention of acute rejections, but data comparing tacrolimus with Neoral are scarce. A total of 128 consecutive renal transplant recipients was studied. The patients were treated with Neoral-based (n = 74) or tacrolimus-based (n = 54) immunosuppressive regimens. Survival analyses (Cox regression analysis) were performed on an intention-to-treat basis. Renal function and cardiovascular risk profile were analyzed by means of a repeated-measures analysis of variance (ANOVA) up to 12 months after transplantation. Immunological features were less favorable in the tacrolimus group. Two-year patient and graft survival were comparable. Acute-rejection-free survival was 82 % in the tacrolimus group versus 40 % in the Neoral group (P < 0.0001). The severity of the rejections (1997 Banff classification) was comparable (P = 0.43). Immunological graft loss (3.7 % vs 12.2 %, P = 0.02) and conversion because of rejection (0 % vs 28.4 %, P < 0.001) were less in the tacrolimus group. A higher proportion (68.5 % vs 14.9 %, P < 0.001) was successfully put on monotherapy. Creatinine clearance, proteinuria, and fractional uric acid clearance were similar. In the tacrolimus group mean blood pressure was comparable, but patients needed less anti-hypertensive drugs (P < 0.001) and, even with fewer patients on lipid-lowering drugs, total cholesterol was lower (5.2 vs 6.0 mmol/l, P = 0.003). Treatment for post-transplant diabetes mellitus was 18.5 % versus 10.8 % (P = 0.22). In both groups, antidiabetic medication could be withdrawn for most patients. This study indicates that tacrolimus is superior to cyclosporine-Neoral in preventing acute rejection with comparable patient and graft survival rates. Because of a lower need for treatment of hypertension and hypercholesterolemia, the cardiovascular risk profile is more favorable. A considerable proportion of patients can be successfully weaned off co-medication and treated with tacrolimus monotherapy.

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Received: 17 July 2000 Revised: 31 May 2001 Accepted: 21 June 2001

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Boots, J., van Duijnhoven, E., Christiaans, M. et al. Single-center experience with tacrolimus versus cyclosporine-Neoral in renal transplant recipients. Transpl Int 14, 370–383 (2001). https://doi.org/10.1007/s001470100002

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  • Keywords Tacrolimus
  • Cyclosporine
  • Neoral
  • Survival
  • Rejection
  • Clinical outcome