3rd Department of Internal Medicine and Nephrology, University Hospital Olomouc, Olomouc, Czech Republic.
Transpl Int. 2010 Apr 1;23(4):364-73. doi: 10.1111/j.1432-2277.2009.00995.x. Epub 2009 Nov 9.
The purpose of the prospective study was to determine the prevalence of subclinical toxicity of calcineurin inhibitors (CI) in repeated protocol renal allograft biopsies and to assess its impact on the development of chronic graft changes. A total of 424 biopsies were conducted in a cohort of 158 patients; of these biopsies, 158 were in the third week, 142 were in the third month and 124 were in the first year after transplantation. Histological signs of toxicity occurred in the third week in 33 (20.1%) patients, with persistence after CI dose reduction in the third month in 27 (19.0%) and in the first year in 23 (18.5%) patients. Of the toxic changes, 52% were clinically silent. At the end of the one-year follow-up, both subclinical and clinically manifest toxicity resulted in a similar progression of chronic changes quantified by Banff chronicity score and they significantly differed from the control group (P < 0.05). Subclinical toxicity affects a significant percentage of grafts; it occurs independently of dosage, blood level and type of applied CI. It is associated with the progression of chronic changes as early as in the first year after transplantation and represents an independent risk factor for chronic allograft damage. We report here our clinical approach to toxicity.
这项前瞻性研究的目的是确定钙调磷酸酶抑制剂 (CI) 的亚临床毒性在重复方案肾移植活检中的发生率,并评估其对慢性移植物变化发展的影响。在 158 名患者的队列中进行了总共 424 次活检;这些活检中,158 次在移植后第 3 周,142 次在第 3 个月,124 次在第 1 年。在第 3 周,33 名(20.1%)患者出现毒性的组织学迹象,在减少 CI 剂量后第 3 个月 27 名(19.0%)和第 1 年 23 名(18.5%)患者中持续存在。在毒性变化中,52%是临床无症状的。在一年的随访结束时,无论是亚临床还是临床表现的毒性,都导致慢性变化的进展相似,通过 Banff 慢性评分定量,并与对照组显著不同(P<0.05)。亚临床毒性影响了大量的移植物;它独立于剂量、血药浓度和应用的 CI 类型发生。它与慢性变化的进展有关,早在移植后第 1 年就已经发生,并代表慢性移植物损伤的独立危险因素。我们在此报告我们对毒性的临床处理方法。