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Calcineurin Inhibitors and Uric Acid Control in Solid Organ Transplantation: A Systematic Review
Francesca K Martino1, Marco Bogo1, Ludovica Brunetta1
1Nephrology, Dialysis and Transplantation Unit, Department of Medicine (DIMED), University of Padova, 35128 Padua, Italy.
Medical Sciences (Basel, Switzerland)
|April 24, 2026
Summary
Calcineurin inhibitors like cyclosporin and tacrolimus may impact uric acid control in transplant patients, potentially increasing cardiovascular risk. However, study quality and conflicting results prevent definitive conclusions on their comparative effects.
Area of Science:
- Nephrology
- Pharmacology
- Cardiology
Background:
- Asymptomatic hyperuricemia is linked to increased cardiovascular risk.
- Calcineurin inhibitors (cyclosporin, tacrolimus) may impair uric acid control.
- Widespread use in transplantation raises concerns about cardiovascular risk in this population.
Purpose of the Study:
- To systematically review the role of calcineurin inhibitors in hyperuricemia risk.
- To compare calcineurin inhibitors with other immunosuppressants.
- To clarify differences between cyclosporin and tacrolimus regarding hyperuricemia.
Main Methods:
- Systematic review of MEDLINE and Embase databases.
- Inclusion of adult transplant recipients.
- Keywords: calcineurin inhibitor, uric acid, hyperuricemia, transplant, transplantation.
Main Results:
- 36 studies were included; 28 focused on kidney transplants.
- Hyperuricemia prevalence ranged from 30-80% with calcineurin inhibitors, slightly higher for cyclosporin than tacrolimus.
- Study quality was generally low to moderate, with limited focus on uric acid control.
Conclusions:
- Heterogeneity and low-moderate quality of studies preclude definitive conclusions.
- Comparative effects of cyclosporin and tacrolimus on uric acid remain uncertain.
- Calcineurin inhibitors may affect uric acid control, but confounding factors exist.
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