Objectives: Although conversion of calcineurin inhibitor (CNI)-based immunosuppression to everolimus (EVR) has been shown to improve graft function, no histopathological evidence has been reported. The aim of this study was to evaluate the effect of tacrolimus (TAC) reduction with EVR addition in the maintenance immunosuppression for the recipients with calcineurin inhibitor arteriolopathy (CNIA).

Methods: This study consisted of 18 kidney allograft recipients who were found to have CNIA on protocol biopsy specimens. The time of intervention was 9-89 months posttransplant. All the patients were on TAC, mycophenolate mofetil (MMF). EVR was added and TAC doses were reduced. MMF was continued. Revaluation biopsy was taken 12 months after the intervention. TAC trough levels (TACC0, ng/mL), EVR trough levels (EVRC0, ng/mL), estimated glomerular filtration rate (eGFR, mL/min), and urine protein per creatinine (uP/Cr, g/g creatinine) were compared between pre- and 1 year post-intervention. Changes in histopathological findings and adverse events were also reviewed.

Results: Aah scores improved in 9 patients. Aah scores did not change in the rest of the patients. No deterioration in aah score was observed. No improvement was seen in those with aah3 at pre-intervention. TACC0 reduced from 3.5 to 2.4. EVRC0 at revaluation was 4.0. eGFR improved from 44.1 to 49.7. uP/Cr slightly increased from 0.20 to 0.25. EVR was discontinued in a patient due to an adverse event. EVR dose was reduced in 7 patients due to adverse events.

Conclusions: TAC reduction with EVR addition improves CNIA histologically in selected cases.

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