Comparison of the effectiveness of cyclosporine and tacrolimus in preventing acute rejection and their effects on kidney functions.

Objective: The aim of this study is to compare the effects of cyclosporine (CsA) and tacrolimus (TAC) on preventing acute rejection and analyze the side-effect profiles of both agents, particularly on kidney functions.

Patients And Methods: In our study, 71 patients who underwent heart transplantation were included. For maintenance immunosuppression, 28 of these patients were treated with mycophenolate mofetil (MMF), steroid, and steroid CsA, and 43 of them were treated with MMF steroid and TAC. Endomyocardial biopsy results of the patients in the first month and the first year were compared. In the follow-ups, creatinine values and other parameters were recorded.

Results: Endomyocardial biopsy (EMB) performed at 1 month showed no rejection in 12 patients (42.9%) in the CsA group, grade 1R rejection in 15 patients (53.6%), and grade 2R rejection in one patient (3.6%). In the TAC group, rejection was not detected in 25 patients (58.1%), while grade 1R rejection was diagnosed in 17 patients (39.5%) and grade 2R rejection in 1 patient (2.3%) (p=0.4). In EMBs performed in the first year, 14 patients (51.9%) in the CsA group did not have rejection, 12 patients (44.4%) had grade 1R rejection, and one patient (3.7%) had grade 2R rejection. In the TAC group, grade 0R rejection was diagnosed in 23 patients (60.5%), grade 1R rejection in 15 patients (39.5%), and grade 2R rejection was not detected. Postoperative first-week creatinine values, which were found to be higher in the CsA group, were significant compared to the TAC group (p=0.028).

Conclusions: TAC and CsA are drugs that help prevent acute rejection after heart transplantation and can be used safely in heart transplant recipients. Neither drug is superior to the other in preventing rejection. TAC may be preferred to CsA as it has fewer negative effects on kidney functions in the early postoperative period.