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Tacrolimus reduction with everolimus addition for calcineurin inhibitor‐induced arteriolopathy in kidney allografts
Author(s) -
Miura Masayoshi,
Higashiyama Hiroshi,
Fukasawa Yuichiro,
Itoh Yosuke,
Tamaki Tohru
Publication year - 2015
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.12456
Subject(s) - medicine , urology , calcineurin , tacrolimus , adverse effect , renal function , everolimus , immunosuppression , trough level , creatinine , biopsy , kidney , mycophenolic acid , surgery , transplantation
Aim The aim of this study was to evaluate the effect of tacrolimus ( TAC ) reduction with everolimus ( EVR ) addition on the maintenance immunosuppression for the recipients with calcineurin inhibitor arteriolopathy ( CNIA ). Methods This retrospective study consisted of 13 kidney allograft recipients who were found to have CNIA on protocol biopsy specimens. The time of intervention was 9–89 months. All the patients were on TAC , mycophenolate mofetil ( MMF ). 9 of 13 were on steroid. EVR was added and TAC dose was reduced. MMF dose was not changed. Revaluation biopsy was taken 12 months after the intervention. TAC trough levels ( TACC 0 , ng/mL), EVR trough levels ( EVRC 0 , ng/mL), estimated glomerular filtration rate ( eGFR , mL/min), and urine protein per creatinine ( uP / Cr , g/g creatinine) were compared before and 1 year after intervention. Changes in pathological findings and adverse events were also reviewed. Results Aah scores improved in 5 patients. Aah scores did not change in the rest of the patients. No deterioration was observed. No improvement was seen in those with aah3. TACC 0 reduced from 3.3 to 2.3. EVRC 0 at revaluation was 4.1. eGFR improved from 44.3 to 49.8. uP / C r slightly increased from 0.20 to 0.26. EVR was discontinued in 1 patient due to an adverse event. EVR dose was reduced in 5 patients due to adverse events. Conclusion TAC reduction with EVR addition improves CNIA histologically in selected cases.