Reverse Diastolic Intrarenal Flow Due to Calcineurin Inhibitor (CNI) Toxicity

Böger, Carsten A.; Rümmele, Petra; Mihatsch, Michael J.; Banas, Bernhard; Krämer, Bernhard K.

doi:10.1111/j.1600-6143.2006.01381.x

Cited by 12 publications

(2 citation statements)

References 20 publications

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“…With the increasing use of different immunosuppressive combinations after transplantation, their influence on early graft function should be better characterized. Calcineurin inhibitor toxicity is well‐known to affect graft function through its renal vasoconstrictive effects (5).…”

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confidence: 99%

Potential influence of tacrolimus and steroid avoidance on early graft function in pediatric renal transplantation

Weintraub²,

Concepción

et al. 2008

Pediatric Transplantation

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With the increasing adoption of steroid-sparing immunosuppression protocols in renal transplantation, it is important to evaluate any adverse effects of steroid avoidance on graft function. Early graft function, measured by CrCl was retrospectively studied in 158 consecutive pediatric renal transplant recipients from 1996 to 2005, receiving either steroid-free or steroid-based immunosuppression. Patients receiving steroid-free immunosuppression vs. steroid-based immunosuppression had no difference change in CrCl (DeltaCrCl) in the first week post-transplantation (p = 0.12). When stratified by corticosteroid usage, patients with higher tacrolimus trough levels (> or =14 ng/mL) had slower graft function recovery in the first week post-transplantation than those with lower tacrolimus trough levels (p = 0.008) in the steroid-free group only. Despite initial slower graft function recovery in this subgroup, there was no negative impact on graft function in the steroid-free group; in fact steroid-free patients trended towards better CrCl at six months (p = 0.047) and 12 months (p < 0.001) post-transplant than the steroid-based group. With the improved immunological outcomes with steroid avoidance, close surveillance should be performed of tacrolimus levels to avoid levels >14 ng/mL. In patients with slow recovery of early graft function, short-term perioperative steroids may be considered.

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mentioning

confidence: 99%

Potential influence of tacrolimus and steroid avoidance on early graft function in pediatric renal transplantation

Weintraub²,

Concepción

et al. 2008

Pediatric Transplantation

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“…[10,11] Reversible histological changes have also been demonstrated including, on rare occasions, thrombotic microangiopathy. [12][13][14] CCBs such as nicardipine are commonly used to manage hypertension both before and after renal transplantation. Nicardipine inhibits the cytochrome P450 enzyme CYP3A4, which along with CYP3A5 is involved in the metabolic pathway for tacrolimus in the liver.…”

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confidence: 99%

Tacrolimus-induced Segmental Renal Artery Vasoconstriction in the Setting of Nicardipine Administration after Renal Transplantation

Goldooz

Kennedy

Campsen

2018

AJS

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Immediate postoperative complications in renal transplants include renal artery thrombosis and dissection both of which carry significant risk for loss of the graft. We present an unusual case in which apparent devascularization of the upper pole of the transplant kidney was due to reversible vasospasm as a result of a drug interaction. Tacrolimus, a calcineurin inhibitor, is used for post-transplant immunosuppression. The antihypertensive medication nicardipine impairs liver metabolism of tacrolimus and, in this case, the combination of drugs resulted in supratherapeutic levels of tacrolimus causing acute nephrotoxicity as well as profound vasoconstriction which was most pronounced in the upper pole branch renal artery and simulated devascularization of almost half of the transplant kidney. This case highlights the fact that not all abnormal post-transplant Doppler findings are due to surgical technique or embolic events and illustrates the importance of drug interactions in this group of patients with complex medical conditions.

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