A new meta-analysis finds that tacrolimus is linked to lower mortality, fewer acute rejection episodes, and less hypertension compared to ciclosporin during the first year after liver transplantation. However, the immunosuppressant is also tied to a higher risk of post-transplant diabetes.
Across 12 randomized trials, 89.7% of patients on tacrolimus survived at 12 months versus 86.3% on ciclosporin-a relative mortality risk of 1.31 for ciclosporin. Acute rejection occurred in 24.6% of tacrolimus patients compared to 28.3% with ciclosporin. Hypertension rates were also better with tacrolimus: about 25% versus nearly 33%.
But the trade-off was significant: more than one in five tacrolimus patients developed post-transplant diabetes, compared to 13.5% in the ciclosporin group. No clear difference in graft loss at one year was observed, though study heterogeneity was noted.
Common causes of death included sepsis, hepatic artery thrombosis, and recurrence of primary disease. Researchers caution that kidney function reporting was insufficient for analysis, and some studies used higher drug levels than current practice. Treatment decisions remain individualized.