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BACKGROUND: Mostliver transplant recipients receive either cyclosporin or tacrolimus to preventrejection. Both drugs inhibit calcineurin phosphatase which is thought to bethe mechanism of their anti-rejection effect and principle toxicities. Thedrugs have different pharmacokinetic profiles and potencies. Several randomisedclinical trials have compared cyclosporin and tacrolimus in liver transplantrecipients, but it remains unclear which is superior. OBJECTIVES: To evaluatethe beneficial and harmful effects of immunosuppression with cyclosporin versustacrolimus for liver transplanted patients. SEARCH STRATEGY: The CochraneHepato-Biliary Group Controlled Trials Register, the Cochrane Central Registerof Controlled Trials in The Cochrane Library, MEDLINE, EMBASE, and ScienceCitation Index Expanded, and conference proceedings were searched (August 2005)to identify relevant randomised clinical trials. Our search included scanningof reference lists in relevant articles and correspondence with investigatorsand pharmaceutical companies. SELECTION CRITERIA: All randomised clinicaltrials where tacrolimus was compared with cyclosporin for the initial treatmentof first-time liver transplant recipients. We included randomised trialsirrespective of blinding, language, and publication status. DATA COLLECTION ANDANALYSIS: The primary outcome measure was all-cause mortality. Data weresynthesised (fixed-effect model) and results expressed as relative risk (RR),values less than 1.0 favouring tacrolimus, with 95% confidence intervals (CI).Two authors assessed trials for eligibility, quality, and extracted dataindependently. MAIN RESULTS: We included 16 randomised trials. The number ofdeaths was 254 inthe tacrolimus group (1899 patients) and 302 in the cyclosporin group (1914 patients).At one year, mortality (RR 0.85, 95% CI 0.73 to 0.99) and graft loss (RR 0.73,95% CI 0.61 to 0.86) were significantly reduced in tacrolimus-treatedrecipients. Tacrolimus reduced the number of recipients with acute rejection(RR 0.81, 95% CI 0.75 to 0.88), and steroid-resistant rejection (RR 0.54, 95%CI 0.47 to 0.74) in the first year. Differences were not seen with respect tolymphoproliferative disorder or de-novo dialysis rates, but more de-novoinsulin-requiring diabetes mellitus (RR 1.38, 95% CI 1.01 to 1.86) occurred inthe tacrolimus group. More patients were withdrawn from cyclosporin therapythan from tacrolimus (RR 0.57, 95% CI 0.49 to 0.66). AUTHORS' CONCLUSIONS:Tacrolimus is superior to cyclosporin in improving survival (patient and graft)and preventing acute rejection after liver transplantation, but it increasesthe risk of post-transplant diabetes. Treating 100 recipients with tacrolimusinstead of cyclosporin would avoid acute rejection and steroid-resistantrejection in nine and seven patients, respectively, and graft loss and death infive and two patients, respectively, but four additional patients would developdiabetes after liver transplantation.Leggil'articolo: è full text!