Calcineurin Inhibitor Toxicity in Solid Organ Transplantation

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Andrea Karolin1, Vera Genitsch2, Daniel Sidler1

  • 1Department for Nephrology and Hypertension, University Hospital Insel Bern, Bern, Switzerland.

Pharmacology
|June 15, 2021
PubMed

Insights

Calcineurin inhibitors (CNIs) are vital for organ transplant immunosuppression but cause significant toxicity. This review details calcineurin inhibitor toxicity (CNT) and strategies to mitigate its effects in solid organ transplantation (SOT).

Area of Science:

  • Nephrology
  • Immunology
  • Pharmacology

Background:

  • Calcineurin inhibitors (CNIs) are essential for immunosuppression in solid organ transplantation (SOT).
  • CNIs possess a narrow therapeutic window, necessitating careful dosing and monitoring.
  • A significant number of patients experience short- or long-term calcineurin inhibitor toxicity (CNT).

Purpose of the Study:

  • To review the pathophysiology, clinical presentation, and histological features of CNT.
  • To focus on the renal manifestations of CNT.
  • To explore strategies for reducing CNT burden in SOT patients.

Main Methods:

  • Literature review and synthesis of existing research on CNT.
  • Discussion of clinical and histological findings related to CNT.
  • Analysis of CNI-sparing and CNI-free regimens.

Main Results:

  • CNT encompasses various adverse effects, including nephrotoxicity, hypertension, neurotoxicity, and metabolic disturbances.
  • Renal manifestations are a key concern in CNT.
  • CNI-sparing and CNI-free regimens are being investigated to reduce toxicity.

Conclusions:

  • CNT poses a significant challenge in SOT, impacting patient outcomes.
  • Understanding CNT's multifaceted nature, especially renal effects, is crucial.
  • Developing alternative immunosuppressive strategies is vital for improving long-term SOT success.
Keywords:
ArteriohyalinosisCalcineurin inhibitorsCyclosporine AFibrosisKidney disease

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