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Cited by 6Transplantation: Methods and OutcomesRenal Transplantation Outcomes and TreatmentsOrgan and Tissue Transplantation Research

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

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Pitre, Tyler, Gurupatham, Samuel, Desai, Kairavi, Binnie, Matthew, Martinu, Tereza, Juvet, Stephen, Zeraatkar, Dena·2025·BMJ Open Respiratory Research
DOI 10.1136/bmjresp-2024-002672PMC PMC11987090
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Abstract

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.

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Crossref · 10.1136/bmjresp-2024-002672

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  • Cyclosporine-based immunosuppressive regimens have been shown to be inferior to tacrolimus-based therapy, with higher rates of acute cellular rejection and increased CLAD incidence.

    “This finding is plausible, as cyclosporine-based immunosuppressive regimens have been shown to be inferior to tacrolimus-based therapy, with higher rates of acute cellular rejection and increased CLAD incidence.16, 17, 18, 19, 20”

    From Lung retransplantation during the Lung Allocation Score era: Outcomes from a large single center (2026) · cites this paper as [16]

    The Discussion (Main findings) reports that tacrolimus reduces CLAD risk compared with cyclosporine and probably reduces acute rejection. But the Results (Trial characteristics) say acute rejection was defined using histological criteria in one trial and clinical or histological criteria in two others. The paper therefore does not establish the narrower claim about acute cellular rejection specifically. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

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Research works printed but not linked: 23

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Cited by

Sorted by citations

Authors
Pitre, T., Gurupatham, S., Desai, K., Binnie, M., Martinu, T., Juvet, S., & Zeraatkar, D.
Affiliations
  • University of Toronto (CA)
  • McMaster University (CA)
  • University Health Network (CA)
Corresponding author
Pitre, Tyler
ORCID
Venue
BMJ Open Respiratory Research
Publisher
BMJ
Published
2025-04
Volume
12
Issue
1
Pages
e002672
ISSN
2052-4439 (ISSN-L)
DOI
10.1136/bmjresp-2024-002672
PMC
PMC11987090
OpenAlex
W4409377346
Cited by
6
References
11
Citations by year
2026: 5 · 2025: 1
FWCI
1.45
Type
journal article
Language
en
Open access
Licence
Locations
  • BMJ Open Respiratory Research (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
  • Health Sciences › Medicine › Transplantation › Renal Transplantation Outcomes and Treatments
  • Health Sciences › Medicine › Transplantation › Organ and Tissue Transplantation Research
Keywords
tacrolimus, cyclosporine, lung transplantation, calcineurin inhibitors, immunosuppression, chronic lung allograft dysfunction, acute rejection, mortality, new-onset diabetes, renal dysfunction
MeSH terms
Graft Rejection, Humans, Immunosuppressive Agents, Randomized Controlled Trials as Topic, Lung Transplantation, Tacrolimus, Cyclosporine, Calcineurin Inhibitors

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