Long-term tacrolimus versus long-term ciclosporin in renal transplant recipients with poor graft function

Abstract

This commentary discusses the 5-year results of the multicenter Chronic Renal Allograft Failure (CRAF) study reported by Shihab et al. in which kidney transplant recipients with poor renal function were randomized to either remain on ciclosporin treatment or switch to tacrolimus. Five years after the switch, creatinine clearance had increased by 1.2 ml/min in the tacrolimus group and decreased by 4.1 ml/min in the ciclosporin group (P = 0.019). No difference in patient or graft survival was observed, but more new cardiovascular events occurred in the ciclosporin-treated group. This commentary highlights the problems in interpreting Shihab et al.s study as a direct comparison of ciclosporin and tacrolimus. The benefits of long-term treatment with low-dose calcineurin inhibitors versus calcineurin-inhibitor-free regimens in selected transplant recipients remain to be determined.