Tacrolimus in cardiac transplantation

Abstract

The availability of effective immunosuppressive agents has allowed cardiac transplantation to become an accepted treatment for patients with end-stage heart disease. In recent years, tacrolimus has emerged as a useful alternative to cyclosporine, combined with either azathioprine or the newer antiproliferative agents, mycophenolate mofetil or sirolimus. A number of randomized clinical trials have shown tacrolimus to be comparable with cyclosporine regarding survival and the drug also demonstrates equivalent or improved prophylaxis against acute rejection. The adverse effects of tacrolimus differ from cyclosporine and the drug demonstrates a particularly improved profile with respect to hypertension and dyslipidemia. These data have recently led to regulatory approval of tacrolimus for primary immunosuppression in cardiac transplantation in the USA.