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The efficacy of tacrolimus as an immunosupressant in patients undergoing liver transplantation is well established. Further data have now confirmed the drug's efficacy in patients undergoing kidney transplants. As would be expected, tacrolimus has also shown immunosuppressive efficacy in patients undergoing heart, lung and pancreas transplants.As primary immunosuppression, tacrolimus-based regimens produce similar 1-year graft and patient survival rates as cyclosporin-based regimens. The risk of rejection appears to be lower with tacrolimus, but the clinical value of this is yet to be established. Importantly, tacrolimus can salvage a good proportion of grafts in patients experiencing rejection or toxicity when receiving cyclosporin.The adverse event profile of tacrolimus is typical of that of an immunosuppressive agent. The diabetogenic potential of tacrolimus is greater than that of cyclosporin, and the incidence of neurotoxicity and nephrotoxicity also appears to be higher. However, tacrolimus causes less disturbance of the lipid profile and hypertension than cyclosporin, and hirsutism and gingival hyperplasia are less problematic.