title: Microvascular changes in renal allografts associated with FK506 (Tacrolimus) therapy.
abstract: FK506 (Tacrolimus) recently has been shown to be an effective immunosuppressant after renal transplantation. It is associated with less hypertension, hypercholesterolemia and steroid use compared with cyclosporine. We report 10 patients on FK506 who showed fibrin thrombi within the glomerular capillaries and/or arterioles at renal allograft biopsy. These biopsies were generally performed to assess increasing serum creatinine levels; laboratory evidence of hemolytic uremic syndrome was present in one instance. Plasma or whole blood FK506 levels were elevated in eight of 10 cases. Reduction of immunosuppression led to clinical improvement or biopsy-proven resolution of thrombi in all cases. These observations suggest that FK506 may occasionally produce microvascular changes in the renal allograft. The estimated incidence of this occurrence (1%) is comparable with that reported with cyclosporine (3%).
authors.affiliation: Division of Transplantation Pathology, University of Pittsburgh School of Medicine, Pennsylvania, USA.
authors.forename: P S
authors.initials: PS
authors.lastname: Randhawa
authors.forename: A C
authors.initials: AC
authors.lastname: Tsamandas
authors.forename: M
authors.initials: M
authors.lastname: Magnone
authors.forename: M
authors.initials: M
authors.lastname: Jordan
authors.forename: R
authors.initials: R
authors.lastname: Shapiro
authors.forename: T E
authors.initials: TE
authors.lastname: Starzl
authors.forename: A J
authors.initials: AJ
authors.lastname: Demetris
mesh_terms: D000328:Adult; D000368:Aged; D001160:Arterioles / Q000187:drug effects; D002196:Capillaries / Q000187:drug effects / Q000473:pathology; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D012079:Renal Circulation / Q000187:drug effects; D016559:Tacrolimus / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D013927:Thrombosis / Q000139:chemically induced
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus