Tacrolimus and mycophenolate regimen and subclinical tubulo-interstitial inflammation in low immunological risk renal transplants

Irina B. Torres, Anna V. Reisæter, Francesc Moreso, Anders Âsberg, Marta Vidal, Clara Garcia-Carro, Karsten Midtvedt, Finn P. Reinholt, Helge Scott, Eva Castellà, Maite Salcedo, Christina Dörje, Joana Sellarés, Maria A. Azancot, Manel Perello, Hallvard Holdaas, Daniel Serón

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Abstract

© 2017 Steunstichting ESOT The aim was to evaluate the relationship between maintenance immunosuppression, subclinical tubulo-interstitial inflammation and interstitial fibrosis/tubular atrophy (IF/TA) in surveillance biopsies performed in low immunological risk renal transplants at two transplant centers. The Barcelona cohort consisted of 109 early and 66 late biopsies in patients receiving high tacrolimus (TAC-C 0 target at 1-year 6–10 ng/ml) and reduced MMF dose (500 mg bid at 1-year). The Oslo cohort consisted of 262 early and 237 late biopsies performed in patients treated with low TAC-C 0 (target 3–7 ng/ml) and standard MMF dose (750 mg bid). Subclinical inflammation, adjusted for confounders, was associated with low TAC-C 0 in the early (OR: 0.75, 95% CI: 0.61–0.92; P = 0.006) and late biopsies (OR: 0.69, 95% CI: 0.50–0.95; P = 0.023) from Barcelona. In the Oslo cohort, it was associated with low MMF in early biopsies (OR: 0.90, 95% CI: 0.83–0.98; P = 0.0101) and with low TAC-C 0 in late biopsies (OR: 0.77, 95% CI: 0.61–0.97; P = 0.0286). MMF dose was significantly reduced in Oslo between early and late biopsies. IF/TA was not associated with TAC-C 0 or MMF dose in the multivariate analysis. Our data suggest that in TAC- and MMF-based regimens, TAC-C 0 levels are associated with subclinical inflammation in patients receiving reduced MMF dose.
Original languageEnglish
Pages (from-to)1119-1131
JournalTransplant International
Volume30
Issue number11
DOIs
Publication statusPublished - 1 Nov 2017

Keywords

  • calcineurin antagonists
  • immunosuppression clinical
  • kidney clinical
  • mycophenolate mofetil
  • subclinical rejection
  • tacrolimus

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    Torres, I. B., Reisæter, A. V., Moreso, F., Âsberg, A., Vidal, M., Garcia-Carro, C., Midtvedt, K., Reinholt, F. P., Scott, H., Castellà, E., Salcedo, M., Dörje, C., Sellarés, J., Azancot, M. A., Perello, M., Holdaas, H., & Serón, D. (2017). Tacrolimus and mycophenolate regimen and subclinical tubulo-interstitial inflammation in low immunological risk renal transplants. Transplant International, 30(11), 1119-1131. https://doi.org/10.1111/tri.13002