Background: Calcineurin inhibitors (CNI) are the cornerstone of maintenance immunosuppression after renal transplant. While tacrolimus is recommended over cyclosporine based on studies performed on predominantly Caucasian populations, the comparative benefits and adverse effects in Asian populations remains unclear. 
Methods: A single-centre retrospective chart review was conducted on patients who underwent ABO and HLA compatible renal transplantation between 1stJanuary 2011 to 15thAugust 2018. Patients who received basiliximab induction, prednisolone, mycophenolate and a CNI (either tacrolimus or cyclosporine) were included and followed up over 1 year. Outcomes on patient and graft outcomes, acute rejections, infections and other adverse effects were collected. ​
Results: A total of 169 patients (120 patients received tacrolimus and 49 received cyclosporine). Baseline characteristics had significant differences; patients on tacrolimus were older, had more deceased donor transplants and more HLA mismatches. However, there were no significant differences in patient survival, graft survival, renal function and biopsy-proven acute rejection at 1 year despite adjustment for age, transplant type, DSA presence and number of HLA mismatches. Nevertheless, the tacrolimus group had significantly more admissions for infections (OR 0.27, 95% CI 0.098-0.73, p=0.01), even after adjustment for age, transplant type, number of HLA mismatches, DSA presence and acute rejections. In particular, more severe infections including tissue-invasive CMV and BK virus infections, and opportunistic infections (e.g. Norcardia and Parvovirus) were observed in the tacrolimus group. In contrast, a higher proportion of patients on cyclosporine required change to an alternative immunosuppressive agent (p=0.003).
Conclusion: While tacrolimus may be more tolerable over cyclosporine in this study, it was not associated with improved short-term patient survival and allograft outcomes. In addition, tacrolimus may be associated with increased infection risk in our Asian population.