Pathology of Calcineurin and Mammalian Target of Rapamycin Inhibitors in Kidney Transplantation

Rita Leal; Demetra Tsapepas; Russell J Crew; Geoffrey K Dube; Lloyd Ratner; Ibrahim Batal

doi:10.1016/j.ekir.2017.10.010

Pathology of Calcineurin and Mammalian Target of Rapamycin Inhibitors in Kidney Transplantation

Kidney Int Rep. 2017 Oct 27;3(2):281-290. doi: 10.1016/j.ekir.2017.10.010. eCollection 2018 Mar.

Authors

Rita Leal^{1

2}, Demetra Tsapepas³, Russell J Crew⁴, Geoffrey K Dube⁴, Lloyd Ratner⁵, Ibrahim Batal²

Affiliations

¹ Department of Nephrology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
² Department of Pathology and Cell Biology, Columbia University, College of Physicians and Surgeons, New York, New York, USA.
³ Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York, USA.
⁴ Department of Medicine, Division of Nephrology, Columbia University, College of Physicians and Surgeons, New York, New York, USA.
⁵ Department of Surgery, Division of Transplantation, Columbia University, College of Physicians and Surgeons, New York, New York, USA.

Abstract

The recent evolution in immunosuppression therapy has led to significant improvement in short-term kidney allograft outcomes; however, this progress did not translate into similar improvement in long-term graft survival. The latter, at least in part, is likely to be attributed to immunosuppressant side effects. In this review, we focus on the histologic manifestations of calcineurin inhibitor and mammalian target of rapamycin inhibitor toxicity. We discuss the pathologic features attributed to such toxicity and allude to the lack of highly specific pathognomonic lesions. Finally, we highlight the importance of clinicopathologic correlation to achieve a meaningful pathologic interpretation.

Keywords: calcineurin inhibitors; drug toxicity; kidney transplantation; mammalian target of rapamycin; transplant pathology.

Publication types

Review