title: Tacrolimus confers lower acute rejection rates and better renal allograft survival compared to cyclosporine.
abstract: OBJECTIVE
  To compare the impact of tacrolimus (FK) and cyclosporine (CYA) on acute rejection and graft survival and to assess the predominant causes of graft loss between patients receiving these two calcineurin inhibitors (CNIs).
  
  
  METHODS
  Retrospective review of 1835 patients who received a kidney transplant (KTX) between 1999-2012. Patients were grouped based on initial CNI utilized: 1195 in FK group, 640 in CYA group. Data on baseline characteristics, clinical outcomes, and causes of graft loss in both groups were analyzed.
  
  
  RESULTS
  Cumulative acute rejection rates were 14% in the FKvs24% in the CYA group. Despite more marginal donor characteristics in the FK group, these patients had better graft survival rates compared to the CYA group. Three and five year graft survival rates were 88% and 84% respectively in the FK group compared to 79% and 70% respectively in the CYA group (P< 0.001). After multivariate analysis, which controlled for confounders, FK use was a strong predictor for lower acute rejection rates [odds ratio (OR) 0.60, 95%CI: 0.45-0.79] and better renal allograft survival (OR 0.740, 95%CI: 0.58-0.94). Death with a functioning graft was the most common cause of graft loss in both groups. Common causes of death included cardiovascular disease, infections, and malignancies. Chronic allograft nephropathy was also found to be an important cause of graft loss, being more prevalent in the CYA group.
  
  
  CONCLUSIONS
  The use of FK-based maintenance immunosuppression therapy is associated with a significantly lower rate of acute rejection and better graft survival compared to CYA-based regimen. Individualizing immunosuppression through risk-stratified CNI choice may lead to improved outcomes across all spectra of KTX patients.
authors.affiliation: Mahmoud Kamel, Manish Kadian, Titte Srinivas, Maria Aurora Posadas Salas, Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Kamel
authors.affiliation: Mahmoud Kamel, Manish Kadian, Titte Srinivas, Maria Aurora Posadas Salas, Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States.
authors.forename: Manish
authors.initials: M
authors.lastname: Kadian
authors.affiliation: Mahmoud Kamel, Manish Kadian, Titte Srinivas, Maria Aurora Posadas Salas, Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States.
authors.forename: Titte
authors.initials: T
authors.lastname: Srinivas
authors.affiliation: Mahmoud Kamel, Manish Kadian, Titte Srinivas, Maria Aurora Posadas Salas, Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States.
authors.forename: David
authors.initials: D
authors.lastname: Taber
authors.affiliation: Mahmoud Kamel, Manish Kadian, Titte Srinivas, Maria Aurora Posadas Salas, Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States.
authors.forename: Maria Aurora
authors.initials: MA
authors.lastname: Posadas Salas
keywords: Cyclosporine; Renal allograft survival; Tacrolimus