Cyclosporine microemulsion (Neoral) versus tacrolimus (FK506) as maintenance therapy in kidney transplant patients

Abstract

N EORAL AND FK506 are calcineurin inhibitors used to prevent posttransplant rejection.1 Although both yield comparable 1-year patient and graft survivals.2 FK506 may be superior to Neoral to reduce biopsy-confirmed acute rejection episodes,2,3 including steroid-resistant processes.4 Enhanced 5-year graft survival3 and function2 were more frequent in FK506- compared to Neoral-treated patients. The esthetic and metabolic side effects and toxicity of Neoral, such as hypertension and hyperlipidemia,5,6 have limited its use as a primary agent. Increasingly conversion from Neoral to FK506 has been reported, leading to improvements in hypercholesterolemia with minimal risk of rejection or allograft dysfunction.7 Triglyceride blood levels decrease and serum creatinine levels remain stable.8 The absence of an acute rejection episode during conversion8,9 suggests that conversion to FK506 is a safe alternative in cases of hyperlipidemia postkidney transplantation (KT).7,9,10 This improvement in lipid profile and better control of blood pressure11 has resulted in a more favorable cardiovascular risk profile.10 The endpoint is to reduce both immunologic and nonimmunologic causes of chronic allograft dysfunction.12,13 The present study compares the outcome and side effects in groups of KT patients receiving Neoral or FK506.