Tacrolimus versus cyclosporine immunosuppression in lung transplantation: a systematic review and meta-analysis

BACKGROUND: The relative efficacy of calcineurin inhibitors tacrolimus and cyclosporine in lung transplantation remains unclear. To clarify, we conducted a systematic review and meta-analysis. METHODS: We searched through EMBASE, MEDLINE and Cochrane CENTRAL until 23 October 2023 for randomised trials comparing tacrolimus with cyclosporine in lung transplant recipients. Data extraction and bias risk assessment were done independently. Analyses included random effects pairwise meta-analysis and trial sequential analysis, with GRADE system for evidence certainty. RESULTS: We found four eligible trials totalling 662 patients. Tacrolimus significantly reduces the risk of chronic lung allograft dysfunction (RR 0.46, high certainty) and likely decreases acute rejection risk (RR 0.83, moderate certainty), with no clear difference in mortality (RR 1.08, low certainty). It may raise new-onset diabetes mellitus (RR 4.17, low certainty) and renal dysfunction risks (RR 1.27, low certainty). CONCLUSION: Tacrolimus likely lowers acute rejection and chronic dysfunction risks in lung transplant recipients without improving survival rates. However, it might increase the chances of developing diabetes mellitus and renal dysfunction. These findings guide the choice between tacrolimus and cyclosporine, balancing benefits against potential risks.