title: Comparison of tacrolimus with microemulsion cyclosporine as primary immunosuppression in hepatitis C patients after liver transplantation.
abstract: BACKGROUND
  Immunosuppression in patients with hepatitis C virus (HCV) following orthotopic liver transplantation can lead to significant increases in serum viral loads. Our aim was to analyze the effect of a randomized study of two immunosuppressive agents (tacrolimus vs. microemulsion cyclosporine) on the outcome of HCV patients following orthotopic liver transplantation.
  
  
  METHODS
  From December 1995 to September 1996, 50 adult patients transplanted for HCV cirrhosis were randomly assigned to receive tacrolimus (Prograf) (group 1, 25 patients) or microemulsion cyclosporine (Neoral) (group 2, 24 patients). All patients received alpha-interferon after transplantation, and the overall steroid doses were no different between the groups. Serum RNA levels were measured by signal amplification of Chiron. Biopsies were taken when transaminases were greater than 2x base line or when there was an inappropriate response to alterations in immunosuppression regimens.
  
  
  RESULTS
  There were more episodes of rejection in the Neoral group, but there were no differences in bacterial and viral infections, nor in the rate of HCV recurrence between the two groups. There were seven deaths in group 1 and eight in group 2. Overall patient and graft survival rates in the Prograf and Neoral groups at 18 months were 72 and 68% and 67 and 64%, respectively.
  
  
  CONCLUSIONS
  (a) Both immunosuppression regimens had similar HCV recurrence rates; (b) there were no differences in bacterial or opportunistic infections; and (c) patient and graft survival was similar between the two groups.
authors.affiliation: School of Medicine, Department of Transplantation, University of Miami, Florida 33136, USA.
authors.forename: X A
authors.initials: XA
authors.lastname: Zervos
authors.forename: D
authors.initials: D
authors.lastname: Weppler
authors.forename: G P
authors.initials: GP
authors.lastname: Fragulidis
authors.forename: M B
authors.initials: MB
authors.lastname: Torres
authors.forename: J R
authors.initials: JR
authors.lastname: Nery
authors.forename: M F
authors.initials: MF
authors.lastname: Khan
authors.forename: A D
authors.initials: AD
authors.lastname: Pinna
authors.forename: T
authors.initials: T
authors.lastname: Kato
authors.forename: J
authors.initials: J
authors.lastname: Miller
authors.forename: K R
authors.initials: KR
authors.lastname: Reddy
authors.forename: A G
authors.initials: AG
authors.lastname: Tzakis
mesh_terms: D000328:Adult; D000368:Aged; D016572:Cyclosporine / Q000008:administration & dosage / Q000627:therapeutic use*; D004655:Emulsions; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival / Q000276:immunology*; D016174:Hepacivirus / Q000302:isolation & purification*; D006526:Hepatitis C / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000209:etiology / Q000601:surgery*; D016031:Liver Transplantation / Q000276:immunology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012367:RNA, Viral / Q000097:blood; D012008:Recurrence; D012086:Reoperation; D015996:Survival Rate; D016559:Tacrolimus / Q000627:therapeutic use*
chemical_list: D004655:Emulsions; D007166:Immunosuppressive Agents; D012367:RNA, Viral; D016572:Cyclosporine; D016559:Tacrolimus