Tacrolimus and mycophenolate regimen and subclinical tubulo‐interstitial inflammation in low immunological risk renal transplants |
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Authors: | 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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Institution: | 1. Department of Nephrology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain;2. Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway;3. School of Pharmacy, University of Oslo, Norway;4. Department of Pathology, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain;5. Department of Pathology, Oslo University Hospital, Rikshospitalet, Oslo, Norway;6. Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain |
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Abstract: | 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‐C0 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‐C0 (target 3–7 ng/ml) and standard MMF dose (750 mg bid). Subclinical inflammation, adjusted for confounders, was associated with low TAC‐C0 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‐C0 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‐C0 or MMF dose in the multivariate analysis. Our data suggest that in TAC‐ and MMF‐based regimens, TAC‐C0 levels are associated with subclinical inflammation in patients receiving reduced MMF dose. |
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Keywords: | calcineurin antagonists immunosuppression clinical kidney clinical mycophenolate mofetil subclinical rejection tacrolimus |
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