Five RCTs (n=366) were included.
Two studies reported adequate allocation concealment and gave information on the method of randomisation. None were blinded. Two studies used intention-to-treat analysis. One study reported a sample size calculation. All studies were considered to have adequate completeness of follow-up. Three studies reported the use of equivalent concomitant treatment in both treatment groups.
There was no statistically significant difference between TAC-based and cyclosporine-based regimens in mortality (RR 0.72, 95% CI: 0.49, 1.08, p=0.11; based on 5 studies), graft survival (RR 0.86, 95% CI: 0.61, 1.21, p=0.37; based on 4 studies), biopsy-proven acute rejection (RR 0.91, 95% CI: 0.61, 1.36, p=0.65, based on 4 studies), corticosteroid acute rejection (RR 2.25, 95% CI: 0.55, 9.29, p=0.26; based on 2 studies) and fibrosing cholestatic hepatitis (RR 0.96, 95% CI: 0.41, 2.26, p=0.92; based on 2 studies). One study reported no significant difference between treatments in severe fibrosis at 1 year (9 out of 46 with TAC versus 8 out of 44 with cyclosporine).
There were no significant differences between TAC and cyclosporine in complications or neurotoxicity (based on 2 studies) but the studies were heterogeneous (p=0.04; I-squared 76.6%).