Rapamycin-associated post-transplantation glomerulonephritis and its remission after reintroduction of calcineurin-inhibitor therapy

E Dittrich, S Schmaldienst, A Soleiman, WH Hörl… - Transplant …, 2004 - Springer
E Dittrich, S Schmaldienst, A Soleiman, WH Hörl, E Pohanka
Transplant international, 2004Springer
Rapamycin is a new immunosuppressive agent approved for maintenance therapy after
kidney transplantation. It may allow calcineurin-inhibitor-free, non-nephrotoxic
immunosuppression. We report, however, on four kidney-transplant recipients who
developed post-transplantation glomerulonephritis after conversion from a calcineurin-
inhibitor-based immunosuppression to rapamycin. In all four patients nephrotic-range
proteinuria occurred 2–9 months after conversion to rapamycin. Renal biopsy confirmed …
Abstract
Rapamycin is a new immunosuppressive agent approved for maintenance therapy after kidney transplantation. It may allow calcineurin-inhibitor-free, non-nephrotoxic immunosuppression. We report, however, on four kidney-transplant recipients who developed post-transplantation glomerulonephritis after conversion from a calcineurin-inhibitor-based immunosuppression to rapamycin. In all four patients nephrotic-range proteinuria occurred 2–9 months after conversion to rapamycin. Renal biopsy confirmed membrano-proliferative glomerulonephritis type 1 in one case, membranous glomerulonephritis in another and IgA-nephropathy in two cases, respectively. Calcineurin-inhibitor-based immunosuppression was reintroduced and resulted in complete remission of proteinuria and in stabilised renal function in all patients. We conclude that in the case of rapamycin-associated post-transplantation glomerulonephritis an attempt should be made to replace rapamycin by a calcineurin inhibitor.
Springer