Renal lesions in ciclosporin A-treated kidney transplant patients

Ninety renal biopsies (RB) in 73 out of 152 ciclosporin A (CsA)-treated allograft patients were studied by light and electron microscopy; they were grouped according to the clinical setting: (1) prolonged posttransplant anuria (9 RB), (2) early graft function deterioration (14 RB), (3) late graft function deterioration (15 RB) and (4) control biopsies (52 RB) at least 6 months after Tx. Glomerular, tubular abnormalities, interstitial cellular infiltrate and fibrosis, peritubular capillary mononuclear cell congestion (PCC), vascular changes and erythrocyte extravasation were evaluated and the following morphologic patterns were identified alone or in combination: acute (AR) and acute on chronic rejection (ACR), toxic tubulopathy (TT), interstitial stripe fibrosis (ISF), CsA-associated arteriolopathy (CsAA). AR was observed in 95% of RB in group 1 and 2, and in 26% in group 3, never in group 4; PCC and TT were only observed concomitantly with AR; ACR was found in 26% of group 3; ISF in 53% of group 3, sometimes linked to CsAA and, of moderate entity, in 70% of group 4. CsAA was noted in 10% of all RB, mainly in group 3 (26%), although in some RB of group 2 (13%) as well.