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Cyclosporine A or Tacrolimus for Hepatitis C Recurrence? An Old Debate

The controversy on the efficacy and safety of cyclosporine A (CsA) versus tacrolimus (TAC) remains a long-standing debate well-known to transplant programs. It is generally accepted that TAC is a more powerful immunosuppressant than CsA, one that has fewer side effects on kidney function, blood pressure, lipid metabolism and, importantly, on so-called aesthetic effects (hirsutism, gingival hypertrophy). For these reasons, TAC is prescribed as the main calcineurin inhibitor in most liver transplant programs. The use of CsA is generally limited to cases of neurologic side effects or in some patients with diabetes mellitus. The potential influence of this calcineurin inhibitor on hepatitis C recurrence has been a matter of controversy for many years, with some articles suggesting better outcomes in patients treated with TAC versus CsA (1–3) and vice versa (4). Most reports, however, support the idea that the choice of calcineurin inhibitor does not impact the histologic severity of recurrent hepatitis C (5,6).