title: Effect of steroid-free low concentration calcineurin inhibitor maintenance immunosuppression regimen on renal allograft histopathology and function.
abstract: BACKGROUND
  The most common cause of late kidney transplant failure is insidiously progressive renal dysfunction associated with organ scarring and fibrosis. Advanced donor age, delayed graft function, calcineurin toxicity and repeated acute rejection episodes are risk factors for this pathophysiology.
  
  
  METHODS
  We employed 3, 12 and 24 months surveillance renal biopsies, scored using the Chronic Allograft Damage Index (CADI), with periodic estimates of glomerular filtration rate (eGFR) to assess the effect of a steroid-free maintenance immunosuppression regimen on allograft histology and function. Ninety-one patients were induced with Alemtuzumab and then treated with mycophenolate sodium and low trough concentrations of tacrolimus.
  
  
  RESULTS
  Fifty-six of 91 patients followed for 24 months showed no clinical rejection and in 16 more only minimal histological or borderline changes as defined by Banff criteria were observed. Histologically acute rejection was observed in 14 patients including two detected on surveillance biopsy. Five patients refused biopsies but showed stable eGFR for 24 months. Graft histopathology in the group with no rejection did not worsen. In contrast, nearly half the patients with acute rejection showed progression of CADI scores and a total of four grafts were lost over the 2 years. The 16 patients with borderline rejection changes exhibited stable glomerular filtration rate throughout, but 12.5% showed progression of CADI scores in the 12- to 24-month period.
  
  
  CONCLUSIONS
  Following Alemtuzumab induction and in conjunction with low-dose tacrolimus and mycophenolate, continuous steroid therapy was not required to prevent progressive injury or preservation of graft function in patients without biopsy-proven acute rejection. Scored surveillance renal biopsies provide a useful tool to monitor transplanted kidneys.
authors: Renal/Pancreas Transplant Unit, Erie County Medical Center, Buffalo, New York, USA.
authors: Neha
authors: N
authors: Nainani
authors: Nilang
authors: N
authors: Patel
authors: Nauman
authors: N
authors: Tahir
authors: Rakesh
authors: R
authors: Kumar
authors: Edit
authors: E
authors: Weber-Shrikant
authors: Aijaz A
authors: AA
authors: Gundroo
authors: Brian M
authors: BM
authors: Murray
authors: Kathleen M
authors: KM
authors: Tornatore
authors: George A
authors: GA
authors: Blessios
authors: Rocco C
authors: RC
authors: Venuto
mesh_terms: D000328:Adult; D000074323:Alemtuzumab; D061067:Antibodies, Monoclonal, Humanized / Q000494:pharmacology* / Q000627:therapeutic use; D001706:Biopsy; D065095:Calcineurin Inhibitors; D002921:Cicatrix / Q000473:pathology; D004305:Dose-Response Relationship, Drug; D005260:Female; D005355:Fibrosis; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology* / Q000627:therapeutic use; D007668:Kidney / Q000187:drug effects / Q000473:pathology; D016030:Kidney Transplantation / Q000276:immunology* / Q000473:pathology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D016559:Tacrolimus / Q000494:pharmacology* / Q000627:therapeutic use; D014184:Transplantation, Homologous
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D000074323:Alemtuzumab; D009173:Mycophenolic Acid; D016559:Tacrolimus