Tacrolimus: immunosuppression following liver and kidney transplant

Advances in transplantation have been impressive since the introduction of cyclosporin, however, there is still considerable debate on the most suitable immunosuppressant regimen. Tacrolimus, a new macrolide immunosuppressant, was marketed in the U.K. in 1994. Open studies have demonstrated its equal efficacy to cyclosporin in terms of patient and graft survival rates when used for primary immunosuppression following both liver and kidney transplantations. Tacrolimus also provides a valuable alternative for patients experiencing rejection in whom re-transplantation is often the only alternative. Unfortunately, in the studies to date, tacrolimus use was associated with increased nephrotoxicity and neurotoxicity compared to cyclosporin. Further trials are therefore required to define tacrolimus' true value in this complex field.