PMID- 10751057
OWN - NLM
STAT- MEDLINE
DCOM- 20000605
LR  - 20131121
IS  - 0902-0063 (Print)
IS  - 0902-0063 (Linking)
VI  - 13 Suppl 1
DP  - 1999
TI  - Clinical and histological analysis of acute tacrolimus (TAC) nephrotoxicity in 
      renal allografts.
PG  - 48-53
AB  - Tacrolimus (TAC) is an effective primary immunosuppressive agent in kidney 
      transplantation. Acute nephrotoxicity due to TAC in kidney transplant patients is 
      either similar to, or significantly more frequent than that of cyclosporin A 
      (CsA). In this study we describe the clinico-morphologic characteristics of acute 
      TAC nephrotoxicity in kidney transplant recipients. PATIENTS AND METHODS: We 
      studied retrospectively the clinical courses of 67 patients who underwent kidney 
      transplantation under TAC immunosuppression at Tokyo Women's Medical University 
      between July 1990 and January 1997. We compared the recipient's characteristics 
      with and without acute TAC nephrotoxicity. We also studied retrospectively the 
      clinico-morphologic profiles of the acute TAC nephrotoxicity with 16 kidney 
      transplant recipients under TAC immunosuppression, who were diagnosed with acute 
      TAC nephrotoxicity by allograft biopsies between January 1996 and January 1997. 
      RESULTS: There were no significant differences between acute TAC nephrotoxicity 
      and non-nephrotoxicity groups about age, sex, donor source, age of donor, the 
      proportion of ABO incompatible and the number of human leukocyte antigen (HLA) 
      mismatches. Of 27 acute TAC nephrotoxicity recipients, 7 patients (26%) had 
      moderate-to-severe grade arteriosclerosis in their allograft arteries. The onset 
      of TAC nephrotoxicity occurred 8-69 days post-operatively. The baseline 
      creatinine level was 1.92 mg/dL (range 0.4-5.1 mg/dL) and rose by 38.4% (range 
      0-84.6) during episodes of nephrotoxicity. The mean peak of the whole blood TAC 
      trough level during the toxic episodes was 32.5 ng/mL (range 21.2-58.5 ng/mL). 
      The rise in creatinine level preceded the highest TAC level in 10 cases. A mean 
      reduction in TAC dosage of 18.9% (range 0-50% led to a fall of 17.2% (range 
      0-43%) in serum creatinine levels. The moderate-to-severe arteriosclerosis in 
      allograft arteries was seen in 5 (31%) patients. CONCLUSION: The high trough 
      level of the whole blood TAC and the existence of moderate-to-severe 
      arteriosclerosis in allograft arteries have the potential of causing TAC 
      nephrotoxicities. A reduction of TAC dosage may be effective in improving 
      allograft functions.
FAU - Shimizu, T
AU  - Shimizu T
AD  - Department of Urology, Kidney Center, Tokyo Women's Medical University, Japan.
FAU - Tanabe, K
AU  - Tanabe K
FAU - Tokumoto, T
AU  - Tokumoto T
FAU - Ishikawa, N
AU  - Ishikawa N
FAU - Shinmura, H
AU  - Shinmura H
FAU - Oshima, T
AU  - Oshima T
FAU - Toma, H
AU  - Toma H
FAU - Yamaguchi, Y
AU  - Yamaguchi Y
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - Denmark
TA  - Clin Transplant
JT  - Clinical transplantation
JID - 8710240
RN  - 0 (Immunosuppressive Agents)
RN  - AYI8EX34EU (Creatinine)
RN  - WM0HAQ4WNM (Tacrolimus)
SB  - IM
MH  - Adult
MH  - Arteriosclerosis/pathology
MH  - Creatinine/blood
MH  - Female
MH  - Humans
MH  - Immunosuppressive Agents/*adverse effects/therapeutic use
MH  - Kidney/drug effects/pathology
MH  - *Kidney Transplantation/pathology
MH  - Living Donors
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Tacrolimus/*adverse effects/therapeutic use
MH  - Time Factors
EDAT- 2000/04/06 09:00
MHDA- 2000/06/10 09:00
CRDT- 2000/04/06 09:00
PHST- 2000/04/06 09:00 [pubmed]
PHST- 2000/06/10 09:00 [medline]
PHST- 2000/04/06 09:00 [entrez]
PST - ppublish
SO  - Clin Transplant. 1999;13 Suppl 1:48-53.