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Arteriosclerosis in zero‐time biopsy is a risk factor for tacrolimus‐induced chronic nephrotoxicity
Author(s) -
Yagisawa Takafumi,
Omoto Kazuya,
Shimizu Tomokazu,
Ishida Hideki,
Tanabe Kazunari
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.12461
Subject(s) - nephrotoxicity , medicine , tacrolimus , calcineurin , kidney disease , urology , risk factor , biopsy , gastroenterology , pathology , transplantation , kidney
Aim Calcineurin inhibitors reduce the acute rejection rate and greatly improve renal allograft survival. However, they are associated with some adverse events, including nephrotoxicity, a risk factor for allograft failure. Chronic calcineurin inhibitor‐induced nephrotoxicity causes irreversible damage to renal components, such as arteriolar hyaline thickening. The aim of this study is to investigate the risk factors for tacrolimus‐induced chronic nephrotoxicity using zero‐time biopsy specimens. Methods Between J anuary 2001 and D ecember 2010, 483 patients who underwent living‐related kidney transplantation and had also been placed on a tacrolimus‐based regimen were enrolled in this study. There were 1859 specimens evaluated comprising 483 zero‐time biopsy specimens and 1376 protocol and for‐cause biopsy specimens. D e novo arteriolar hyaline thickening due to tacrolimus‐induced chronic nephrotoxicity was scored according to the Banff classification aah score. In this study, tacrolimus‐induced nephrotoxicity was defined as a positive aah score. Results Of the 483 patients, 108 patients (22.4%) had biopsy‐proven tacrolimus‐induced chronic nephrotoxicity. Multivariate analysis showed that interlobular arteriosclerosis proven by zero‐time biopsy ( OR : 2.23, 95% CI : 1.38–3.58, P < 0.01) and acute rejection episodes ( OR : 1.58, 95% CI : 1.00–2.47, P = 0.04) were independent risk factors for tacrolimus‐induced chronic nephrotoxicity. However, tacrolimus‐induced chronic nephrotoxicity did not affect long‐term graft survival. Conclusion This is the first report showing that arteriosclerosis in zero‐time biopsy specimens is a risk factor for histological tacrolimus‐induced chronic nephrotoxicity.