Tacrolimus Versus Cyclosporine in Kidney Transplantation

Abstract

Introduction: Calcineurin inhibitors are mainstay immunosuppressants, but optimal choice between tacrolimus and cyclosporine remains uncertain. Methods: Review of 12 randomized controlled trials (RCTs) (1995–2023) comparing acute rejection rates, graft survival, and adverse effects in kidney transplant recipients. Results: Tacrolimus reduced acute rejection by 40% (relative risk 0.6, p<0.001) and improved 5-year graft survival by 8% compared to cyclosporine. However, new-onset diabetes after transplant (NODAT) was higher with tacrolimus (25% vs. 15%). Discussion: Superior immunosuppressive efficacy of tacrolimus outweighs higher metabolic risks. Cyclosporine may be considered for patients at high NODAT risk. Conclusion: Tacrolimus is preferred for standard kidney transplantation.