title: The Interplay between inflammation and fibrosis in kidney transplantation.
abstract: Serial surveillance renal allograft biopsies have shown that early subclinical inflammation constitutes a risk factor for the development of interstitial fibrosis. More recently, it has been observed that persistent inflammation is also associated with fibrosis progression and chronic humoral rejection, two histological conditions associated with poor allograft survival. Treatment of subclinical inflammation with steroid boluses prevents progression of fibrosis and preserves renal function in patients treated with a cyclosporine-based regimen. Subclinical inflammation has been reduced after the introduction of tacrolimus based regimens, and it has been shown that immunosuppressive schedules that are effective in preventing acute rejection and subclinical inflammation may prevent the progression of fibrosis and chronic humoral rejection. On the other hand, minimization protocols are associated with progression of fibrosis, and noncompliance with the immunosuppressive regime constitutes a major risk factor for chronic humoral rejection. Thus, adequate immunosuppressive treatment, avoiding minimization strategies and reinforcing educational actions to prevent noncompliance, is at present an effective approach to combat the progression of fibrosis.
authors.affiliation: Nephrology Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.
authors.forename: Irina B
authors.initials: IB
authors.lastname: Torres
authors.affiliation: Nephrology Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Moreso
authors.affiliation: Renal Physiopathology Department, CIBBIM-Nanomedicine, Vall d'Hebron Research Institute, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.
authors.forename: Eduard
authors.initials: E
authors.lastname: Sarró
authors.affiliation: Renal Physiopathology Department, CIBBIM-Nanomedicine, Vall d'Hebron Research Institute, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.
authors.forename: Anna
authors.identifier: 0000-0003-3833-2249
authors.initials: A
authors.lastname: Meseguer
authors.affiliation: Nephrology Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Serón
mesh_terms: D016572:Cyclosporine / Q000627:therapeutic use; D005355:Fibrosis / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D006084:Graft Rejection / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007249:Inflammation / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D016030:Kidney Transplantation / Q000009:adverse effects*; D016559:Tacrolimus / Q000627:therapeutic use
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus