Tacrolimus Versus Cyclosporine in Low Immunological Risk Patients After Kidney Transplantation Inducted by Anti-Thymocyte Globulin

Abstract

Background 
 Global increase in the incidence of end-stage renal disease has necessitated the performance of kidney transplantation for many patients. To minimize the possibility of renal allograft failure and maintain graft function. Kidney transplant recipients are typically given immunosuppressive drugs such as tacrolimus and Cyclosporine in combination with other drugs.
 Objectives 
 The present study was carried out to compare the effectiveness of tacrolimus versus Cyclosporine.
 Patients and Methods
 The present clinical non-randomized and non-controlled study was conducted on 201 kidney transplant patients in Shar teaching Hospital in Sulaimani, Kurdistan region-Iraq, from April 2020 to April 2021. The patients had received tacrolimus and Cyclosporine as immunosuppression drugs. Required data were collected from the patients through their hospital records and direct interviews with them. The collected data were analyzed through Statistical Package for Social Science (version 22.0).
 Results
 Most patients (60.7%) were aged 19-45 and males (70.6%). Most of them did not know the cause of chronic kidney failure (41.3%), focal segmental glomerulosclerosis in 14.4%, and diabetes mellitus in 12.4%. Most of the donors were non-related (90.5%). Induction treatment was anti-thymocyte globulin for most of them (76.6%), and treatment after transplant, mycophenolate mofetil, Cyclosporine and prednisolone in 75% of them. Acute cellular rejection was the most frequent complication after the transplant (23.4%). Tremor and new onset of diabetes were the most frequent side effects of tacrolimus; however, hirsutism, hyperkalemia, acne, hypertension, and hyperlipidemia are the most frequent side effects Cyclosporine. More patients on Tacrolimus than Cyclosporine developed new onset of diabetes (7.5%). However, serum uric acid (p<0.001), serum cholesterol (p<0.001), and serum triglyceride (p=0.01) levels elevate more with Cyclosporine group patients. Moreover, drug change has a significant association with haemoglobin level (HGB) (p<0.001) and serum triglyceride (p<0.001) in those group drug was changed to tacrolimus.
 Conclusion
 Similar rejection was obtained by using Tacrolimus and Cyclosporine within the first year after kidney transplant in low immunological risk patients; however, acute cellular rejection was less with the TAC group. It is less expensive than Cyclosporine in our region, but Cyclosporine is more available in the hospital.