The Pathologic Impact of Tacrolimus on Protocol Biopsy in Renal Transplant Patients With Basiliximab-Based Immunosuppression

Abstract Forty-two ESRD patients underwent renal transplantation using basiliximab (mean age: 30.6 ± 18.6 years at transplantation; male: 50%; ESRD duration: 51.6 ± 13.0 months) between February, 2000 and July, 2003. All patients had a protocol biopsy on the day of transplant, on discharge from the hospital (35.5 ± 13.2 days), and at 1 year after transplant. The immunosuppression included a calcineurin inhibitor, basiliximab, mycophenolate mofetil (MMF), and methylprednisolone. While 16 patients used tacrolimus (FK group: 29.4 ± 16.6 years old), 26 patients used cyclosporine (CsA group: 31.4 ± 20.1 years old). Protocol biopsies were graded according to the Banff 97 classification. The incidence of acute rejection episodes within 1 year was greater in the CsA (15%) than the FK group (6%). Serum creatinine at hospital discharge was similar (CsA: 1.01 ± 0.59 mg/dL, FK: 0.97 ± 0.49, p = .18); however creatinine at 1 year differed significantly (CyA: 1.22 ± 0.88 mg/dL, FK: 0.92 ± 0.39, P = .03). There was a trend toward an increase in the score of interstitial inflammations in the CsA group, while it remained constant in the FK cohort ( P = .05 at 1 year between the two groups). Other pathologic scores (t, ci, ct, cv, ah) did not differ between the groups at 1 year. Although there were no differences in the demographics between the two groups, there were several trends toward better renal function in the FK group.