***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: OBJECTIVE In this study , we examined whether cyclosporine was effective when combined with everolimus in clinical heart transplantation ( HT ) . PATIENTS AND METHODS From August 2004 to July 2007 , 108 adult patients underwent primary HT . The main exclusion criteria were : donors > 60 years ; cold ischemia times > 6 hours ; recipients of multiorgan transplantation or a previous transplantation ; and panel-reactive antibodies > or = 25 % . The cyclosporine plus everolimus regimen ( group CE , n = 32 ) was suggested first ; upon refusal or if the recipient or donor was positive for hepatitis B surface antigen or PCR + hepatitis C infection , then patient was r and omly assigned to success cyclosporine plus mycophenolate mofetil ( MMF ; group CM , n = 24 ) or tacrolimus plus MMF ( group TM , n = 25 ) . All patients underwent similar operative procedures and postoperative care with protocol endomyocardial biopsies . RESULTS No 30-day mortality was noted in any group . The efficacy failure rates were 3 % , 25 % , and 16 % in groups CE , CM , and TM , respectively ( P = .04 between groups CE and CM ) . The 1-year survivals were 96.7 % + /- 18.1 % , 89.7 % + /- 29.8 % , and 81.0 % + /- 35.5 % for groups CE , CM , and TM , respectively ( P = .04 between groups CE and TM ) . The 3-year survival rates were 91.9 % + /- 28.3 % , 79.8 % + /- 46.0 % , and 81.0 % + /- 35.5 % in groups CE , CM , and TM , respectively . CONCLUSIONS The 3 immunosuppressive regimens offered good efficacy after HT . The cyclosporine plus everolimus regimen showed a significantly better result with less efficacy failure ( compared with cyclosporine plus MMF : 3 % vs 25 % ) and better 1-year survival compared with tacrolimus plus MMF : 96.7 % vs 81.0 % Reduction of allograft rejections remains a primary goal for patients after orthotopic heart transplantation . In an open , multicentre , prospect ively r and omised , parallel group study , patients with primary orthotopic heart transplantation under oral immunosuppressive treatments with tacrolimus ( FK506 ) or cyclosporine ( s and immun )  were compared with respect to medical outcome data . As health-related quality -of-life ( HRQOL ) is also supposed to be an important outcome parameter , it was assessed as a secondary variable in these two patient groups . Patients ' self-rated generic HRQOL was assessed 6 weeks , 3 months , 6 months and 12 months after surgery with the SF-36 question naire , a generic HRQOL instrument . For 70 patients ( 46 under tacrolimus , 24 under cyclosporine )  , intent-to-treat analyses were carried out . The tacrolimus group showed improvements in the different HRQOL subscales of the SF-36 compared to the cyclosporine group . Especially the SF-36 subscales ' vitality ' and ' mental health ' showed statistically higher scores for the tacrolimus group . Aggregating psychological and cognitive subscales in the ' mental component score ' , patients treated with tacrolimus showed a statistically significant improvement compared to the cyclosporine group . The assessment of HRQOL variables in the evaluation of treatment effects proved to be an outcome parameter in this study . The results demonstrate the benefit of tacrolimus with respect to the HRQOL of patients , especially in the psychological dimension BACKGROUND Tacrolimus-based immunosuppression seems safe and effective in liver and kidney transplantation . To assess the safety and efficacy of tacrolimus (TAC)-based immunosuppression after cardiac transplantation as well as the relative impact of tacrolimus on immunosuppression-related side effects such as hypertension and hyperlipidemia , we conducted a prospect i ve , r and omized , open-label , multicenter study of otherwise identical tacrolimus- and cyclosporine-based immunosuppressive regimens in adult patients undergoing cardiac transplantation . METHODS Eighty-five adult patients ( pts ) at six United States cardiac transplant centers , undergoing their first cardiac transplant procedure , were prospect ively r and omized to receive either TAC-based ( n = 39 ) or cyclosporine (CYA)-based ( n = 46 ) immunosuppression . All pts received a triple-drug protocol with 15 pts ( 18 % ) receiving peri-operative OKT3 to delay TAC/CYA due to pre-transplant renal dysfunction . Endomyocardial biopsies were performed at Weeks 1 , 2 , 3 , 4 , 6 , 8 , 10 , 12 , 24 , and 52 . The study duration was 12 months . RESULTS Patients were mostly male ( 87 % ) Caucasian ( 90 % ) with a mean age of 54 years and primary diagnoses of coronary artery disease ( 55 % ) and idiopathic dilated cardiomyopathy ( 41 % ) . There were no significant demographic differences between groups .  Patient and allograft survival were not different in the two groups . The probability and overall incidence of each grade of rejection , whether treated or not , and the types of treatment required did not differ between the groups . At baseline and through 12 months of follow-up , chemistry and hematology values were similar between the groups except serum cholesterol was higher in the CYA group at 3 , 6 , and 12 months ( 239 vs 205 mg/dL , 246 vs 191 mg/dL , 212 vs 186 mg/dL , respectively , p < 0.001 ) . Likewise , LDL-cholesterol , HDL-cholesterol and triglycerides were significantly higher in the CYA group . More CYA patients received therapy for hypercholesterolemia ( 71 % vs 41 % at 12 months , p = 0.01 ) . There were no significant differences in renal function , hyperglycemia , hypomagnesemia , or hyperkalemia during the first 12 months . More CYA patients developed new-onset hypertension requiring pharmacologic treatment ( 71 % vs 48 % , p = 0.05 ) . The incidence of infection was the same for the two groups ( 2.6 episodes/pt/12 month follow-up ) . CONCLUSION Tacrolimus-based immunosuppression seems effective for rejection prophylaxis during the first year after cardiac transplantation and is associated with less hypertension and hyperlipidemia and no difference in renal function , hyperglycemia or infection incidence when compared to cyclosporine-based immunosuppression UNLABELLED This study compares the pharmacokinetics of tacrolimus ( TAC ) and cyclosporine Neoral ( CsA ) in cardiac transplant recipients . METHODS Twenty-six de novo cardiac recipients were prospect ively and r and omly assigned to receive oral TAC- or CsA-based regimens after 5 to 6 days of rabbit antithymocyte globulin induction . Blood sample s were collected at 0 ( before the dose ) and 0.5 , 1 , 2 , 3 , 4 , 6 , 8 , 10 , as well as 12 hours after drug administration . The pharmacokinetics of the first dose ( PK-1 ) and at steady state ( PK-S , 1 month after transplantation ) were analyzed . RESULTS Comparing the AUC per milligram dose , there was no significant difference between PK-1 and PK-S among TAC ( 46.0 + /- 24.3 ng x h/mg x mL versus 69.0 + /- 43.9 ng x h/mg x mL , P = .15 by paired t-test ) , but a significant difference in CsA ( 25.2 + /- 11.4 ng x h/mg x mL versus 45.4 + /- 12.9 ng x h/mg x mL , P = .0005 by paired t-test ) . This means better TAC absorption in the early post-heart transplant period . Using a single-point blood level to predict AUC , TAC showed a significantly higher correlation than CsA at all corresponding sampling times . Besides , C12 in both PK-1 and PK-S of TAC displayed good correlations to the AUC ( r2 = .895 , P = .00 in PK-1 and r2 = .81 , P = .00 in PK-S ) . The TAC trough level was accurate enough to predict the AUC . CONCLUSION The pharmacokinetic profile of TAC is more reliable than that of CsA in the early post-heart transplant period . A high correlation of trough blood levels with AUC omits the requirement for a multiple sampling strategy to more accurately measure AUC as is needed with INTRODUCTION This study compared the efficacy and safety of a tacrolimus (TAC)-based with a cyclosporine (CsA)microemulsion-based immunosuppressive regimen in primary cardiac transplantation . METHODS Heart recipients were r and omly assigned to receive either TAC or CsA regimen after sequential induction with rabbit anti-thymoglobulin . Endomyocardial biopsies were performed at weeks 1 , 2 , 3 , and 4 and months 2 , 3 , and 6 . RESULTS Among 21 adult patients ( TAC , 11 ; CsA , 10 ) in this study , patient survival rates were 100 % in both groups at the end of 6 months . One patient ( 9 % ) in the TAC group experienced acute rejection ( ISHLT > or = 1B ) versus 6 patients ( 60 % ) in the CsA group ( P = .02 ) . The effects on hematology , biochemistry , cytomegalovirus infection , and hemodynamics were similar in both groups except for better lipid profiles in the TAC group . There were no significant differences in severe adverse events . CONCLUSION The TAC-based regimen had a lower risk of acute rejection compared with CsA in heart transplant recipients . The safety profiles were similar in both groups . Therefore , TAC is an alternative to CsA as a primary maintenance immunosuppressant in heart transplantation BACKGROUND To compare the efficacy and safety of tacrolimus and cyclosporine in heart transplantation , this single-center , prospect i ve , r and omized , open-label clinical trial was undertaken . METHODS Seventy-three adult patients were r and omly assigned at the time of transplantation to receive either  tacrolimus ( n=43 ) or  cyclosporine ( n=30 ) as the primary immunosuppressant . Ten of the 43 patients in the tacrolimus group received the drug intravenously in the perioperative period ; all other patients received only oral tacrolimus . RESULTS With a mean follow-up of 27 months , patient survival rates  ( tacrolimus 83 % , cyclosporine 81 % ) were similar . Fewer patients experienced acute rejection in the tacrolimus group ( 79 % ) than in the cyclosporine group ( 100 % ) , but the difference was not statistically significant . The number of infections and dialysis and insulin requirements were similar for the 2 treatment groups , but the proportion of patients requiring multidrug antihypertensive regimens was lower in the tacrolimus group ( 12.5 % vs 50.0 % at month 6 ; p=.025 ) . The interpatient variance in pharmacokinetic parameters in a subset of 10 patients was much higher after the first oral dose of tacrolimus than at steady-state ( eg , first-dose time at which maximal concentration is reached ( t(max ) ) : 3.5+/-2.5h , steady-state t(max ) : 2.0+/-0.7h ) , and patients treated with intravenous tacrolimus ( n=13 ) rather than oral tacrolimus ( n=30 ) reached target concentrations faster and with less interpatient variability ( eg , at day 0 : 9.72+/-10.9 ng/mL intravenously vs 3.31+/-8.1 orally ) . CONCLUSIONS Tacrolimus was associated with similar efficacy and safety profiles compared with cyclosporine . The higher interpatient variance in absorption associated with oral tacrolimus during the first few days after transplantation would suggest that intravenous tacrolimus should be used during the perioperative period The most advantageous combination of immunosuppressive agents for cardiac transplant recipients has not yet been established . Between November 2001 and June 2003 , 343 de novo cardiac transplant recipients were r and omized to receive steroids and either tacrolimus ( TAC ) + sirolimus ( SRL ) , TAC + mycophenolate mofetil ( MMF ) or cyclosporine ( CYA ) + MMF . Antilymphocyte induction therapy was allowed for up to 5 days . The primary endpoint of ≥3A rejection or hemodynamic compromise rejection requiring treatment showed no significant difference at 6 months ( TAC/MMF 22.4 % , TAC/SRL 24.3 % , CYA/MMF 31.6 % , p = 0.271 ) and 1 year ( p = 0.056 ) , but it 
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No significant differences between the two calcineurin inhibitors were found with regard to acute rejections causing haemodynamic instability , diabetes , renal dysfunction , infection , malignancy , or neurotoxicity .
Conclusion Tacrolimus seems to be superior to cyclosporine  in heart transplant patients with regard to hypertension , hyperlipidaemia , gingival hyperplasia and hirsutism .
In addition , tacrolimus seems to be superior to microemulsion cyclosporine in heart transplant patients with regard to a number of outcomes , including death .