Tacrolimus is a macrolide antibiotic with an action very similar to that of cyclosporine. However, it is more potent and has a shorter half-life. It blocks the action of calcineurin, leading to reduction in various transcription factors and IL-2 expression, primarily in T-helper lymphocytes. Tacrolimus can lead to renal toxicity due to afferent arteriolar vasoconstriction and the subsequent reduction in glomerular filtration rate (GFR). Decreasing the dose of tacrolimus can reverse GFR reduction and renal toxicity. Tacrolimus therapy has also been associated with hypertension and neurotoxicity.
Mycophenolate mofetil restrains the proliferation of both T and B cells by inhibiting de novo purine synthesis in these cells. It may be associated with adverse gastrointestinal effects, but it is not as likely as tacrolimus to cause renal dysfunction.
Basiliximab is a chimeric monoclonal antibody to CD25 and an IL-2 antagonist. It is used as an alternative or in addition to steroids for the induction of immunosuppression in solid organ transplantation. It has a relatively safe profile. No cytokine release syndrome has been associated with this drug, but anaphylactic reactions can occur. Basiliximab is unlikely to cause renal dysfunction.
Answer: A
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