Subclinical Lesions and Donor-Specific Antibodies in Kidney Transplant Recipients Receiving Tacrolimus-Based Immunosuppressive Regimen Followed by Early Conversion to Sirolimus.

Autor:	de Sandes-Freitas TV; 1 Nephrology Division, Hospital do Rim/Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil. 2 Instituto de Imunogenética, AFIP, São Paulo, Brazil. 3 Pathology Division, Universidade Federal do Paraná, Curitiba, Brazil. 4 Pathology Division, Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil. 5 Urology Division, Hospital do Rim/Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil., Felipe CR, Campos ÉF, de Lima MG, Soares MF, de Franco MF, Aguiar WF, Tedesco-Silva H, Medina-Pestana JO
Jazyk:	angličtina
Zdroj:	Transplantation [Transplantation] 2015 Nov; Vol. 99 (11), pp. 2372-81.
DOI:	10.1097/TP.0000000000000748
Abstrakt:	Background: There is no evidence on the incidence of subclinical inflammation and scaring lesions in patients receiving tacrolimus (TAC) minimization and elimination immunosuppressive regimens. Methods: This study analyzed preimplantation, 3 and 24 months protocol biopsies and anti-HLA donor-specific antibodies (DSA) in 140 low immunological risk kidney transplant recipients receiving reduced TAC exposure, prednisone, and mycophenolate, randomized at 3 months to be converted or not to sirolimus (SRL). Results: Mean TAC concentrations were 6.0 ± 2.4 ng/mL and 5.8 ± 2.2 ng/mL at 3 and 24 months. The incidence of subclinical inflammation lesions at 3 months was 9.3%. The incidence of (interstitial fibrosis) IF/(tubular atrophy) TA at month 24 was 57.6%, higher in SRL compared to TAC group (68.8 vs 44.4%; P = 0.022). Patients converted to SRL showed higher incidence of acute rejection (7.3% vs 0%), proteinuria (59.6% vs 25%; P = 0.001), and DSA (17.8% vs 7.3%; P = 0.201), respectively. Biopsy-proven acute rejection (odds ratio [OR] 2.32, 95% confidence interval [95% CI], 0.979-5.518, P = 0.056), subclinical inflammation lesions at 3 months (OR, 11.75; 95% CI, 1.286-107.474; P = 0.029) and conversion to SRL (OR, 2.72; 95% CI, 1.155-6.383; P = 0.022) were associated with IF/TA at month 24. Black ethnicity (OR, 0.22; 95% CI, 0.058-0.873; P = 0.031), donor age (OR, 2.74; 95% CI, 1.329-5.649; P = 0.006), and conversion to SRL (OR, 2.34; 95% CI, 1.043-5.267; P = 0.039) were associated with inferior renal function at 24 months. Conclusions: In kidney transplant recipients receiving reduced TAC exposure, subclinical inflammation lesions at 3 months were associated with IF/TA at 24 months. Conversion from TAC to SRL was associated with inferior renal function, higher incidence of IF/TA, and trends to higher incidence of DSA at 24 months.
Databáze:	MEDLINE
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