Objective: To evaluate the effectiveness of tacrolimus and cyclosporine A on acute rejection, chronic rejection and survival rate of patient and graft after renal transplantation. Methods: We searched MEDLINE (1989-Nov. 2004), EMBASE (1989-Nov. 2004), The Chinese Biomedical Database (CBM) (1998-Nov. 2004), Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2004) and handsearched 8 Chinese journals. Trials comparing tacrolimus with cyclosporine A after renal transplantation were included. The quality of included studies such as randomization, blinding, allocation concealment was evaluated and meta-analysis was performed using RevMan 4. 2. 7 software. Results: Eighteen studies involving 3 738 patients were included. Tacrolimus was more effective in decreasing the incidence of acute rejection and chronic rejection than that of cyclosporine A with RR 0.65, 95% CI 0.56 to 0.75 at the end of 6 months; with RR 0.70, 95% CI 0.54 to 0.92 at the end of 12 months for number of patients of acute rejection. The pooled RR was 0.65 (95% CI 0.47 to 0.89) for number of patients of chronic rejection. Tacrolimus could reduce the severity of acute rejection. The relative risks of pathologic grade Banff I and Banff (II + III) were 1.64 (95% CI 1.08 to 2.49) and 0.75 (95% CI 0.63 to 0.89) respectively. But there was no significant difference on the survival rate of patient and graft within 5 years between the two groups. The relative risk of 6, 12, 24, 36 and 60 months were 1.01 (95% CI 0.99 to 1.02), 1.00 (95% CI 0.99 to 1.02), 1.01 (95% CI 0.97 to 1.05), 1.00 (95% CI 0.97 to 1.03) and 0.97 (95% CI 0.88 to 1.07) respectively for the survival rate of patient and 1.04 (95% CI 1.01 to 1.07), 1.03 (95% CI 1.00 to 1.06), 0.99 (95% CI 0.91 to 1.07), 1.04 (95% CI 0.99 to 1.09) and 1.04 (95% CI 0.90 to 1.21) respectively for the survival rate of grafts. Conclusions: On acute rejection and chronic rejection, tacrolimus is more effective than cyclosporine A, but there is no difference in the graft or patient survival rate.