Tacrolimus in the prevention of graft rejection: new indication. Helpful alternative to ciclosporin.

(1) In kidney and liver graft prophylaxis two large multicentre trials have compared tacrolimus to ciclosporin alone or combined with other immunosuppressants. They showed that the mortality one or two years after transplantation, and the incidence of irreversible graft rejection, did not differ according to the treatments received. (2) The safety profile of tacrolimus seems similar to that of ciclosporin, but it is difficult to draw firm conclusions because of inadequate follow-up and recent progress in tacrolimus assay and dose-adjustment methods. Hyperglycaemia, lymphoproliferative syndromes and cardiac effects might be more frequent on tacrolimus than on ciclosporin. (3) Until it is shown that the possible slight advantage of tacrolimus in terms of efficacy is not offset by greater toxicity, tacrolimus should be used only when ciclosporin is ineffective or poorly tolerated.