Tacrolimus/“low-dose” mycophenolate mofetil versus microemulsion cyclosporine/“low-dose” mycophenolate mofetil after kidney transplantation—1-year follow-up of a prospective, randomized clinical trial

INCE its introduction, cyclosporine, a macrolide molecule that inhibits expression of interleukin-2 by lymphocytes, when administered prophylactically in combination with corticosteroids and/or azathioprine, has dramatically improved results of solid organ transplantation. 1 Recently, microemulsion formulation of cyclosporine (Neoral), when compared with CsA, was found to provide better immunosuppression, primarily due to improvement in drug bioavailability. 2 In a multicenter clinical trial, tacrolimus (FK 506), another macrolide molecule with mode of action similar to CsA, was found to be more effective than CsA in the prevention of rejection in renal transplant recipients. 3 Mycophenolate mofetil (MMF), the morpholinoethylester of mycophenolic acid, is an uncompetitive, reversible inhibitor of eukaryotic inosine monophosphate dehydrogenase, a key enzyme in the de novo pathway of purine synthesis during lymphocyte proliferation. 4 In European, tricontinental, and American multicenter clinical trials, MMF in 2- and 3-g doses, when compared with azathioprine/placebo, significantly reduced the incidence of acute rejection in renal transplant recipients. 5‐7