Calcineurin inhibitors in heart transplantation

The calcineurin inhibitors (CNIs) cyclosporine and tacrolimus are routinely used for immunosuppression following heart transplantation in conjunction with an antiproliferative agent with or without maintenance steroids. In randomized multicenter trials both agents showed similar efficacies to prevent rejection and death within the first year after transplant. Neither cyclosporine nor tacrolimus have been shown to prevent coronary allograft vasculopathy. Their use is limited by many side effects like kidney damage, hypertension, new-onset diabetes, and hyperlipidemia, although they may have different cardiovascular side effect profiles. The choice of CNIs seems to be currently dictated by their adverse effect profiles, by the results obtained for the individual patient, and possibly by institutional preference.