Prophylactic isradipine treatment after kidney transpIantation: a prospective double‐blind placebo‐controlled randomized trial

Marinus A. van den Dorpel*, Robert Zietse, Willem Weimar, J. N.M. Ijzermans

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

10 Citations (Scopus)

Abstract

There is evidence that calcium antagonists may have a beneficial effect on cyclosporineinduced nephropathy after transplantation. We treated 50 consecutive non‐diabetic patients receiving their first cadaveric transplant with isradipine, a dihydropyridine calcium antagonist, or placebo in a double‐blind, randomized, placebocontrolled trial. There were no significant differences between the two groups as regards age, weight, sex, HLA matching and ischaemic periods. To achieve optimal vasodilation, treatment was started intravenously 2 h before the transplantation procedure, and continued orally afterwards for 3 months. The immunosuppressive treatment included rabbit antithymocyte globulin on day 0, and oral cyclosporine from day 5. In both groups 7 patients had primary non‐functioning grafts, but the incidence of never functioning kidneys due to vascular and thrombotic complications was significantly higher in the placebo group (0 vs 4 patients, P < 0.05). Hypertension was treated with oral labetolol in combination with guanfacine if necessary. In the placebo group antihypertensive medication had to be prescribed significantly more often (67% vs 33% of patients, P < 0.05), but resulted in similar blood pressure recordings in the two study groups. Cyclosporin A (CsA) plasma concentrations were also comparable but in the isradipine group a significantly higher dose of CsA was needed to achieve adequate levels (8.0 ± 0.5 vs 6.2 ± 0.5 mg/kg per day, P < 0.01). However, in the isradipine‐treated patients creatinine clearance was significantly higher (66.1 ± 4.5 vs 55.6 ± 6.2 ml/min, P < 0.05) after 3 months. We conclude that isradipine is an effective antihypertensive agent after kidney transplantation. Isradipine ameliorates CsA‐induced nephropathy and seems to protect against early postoperative vascular complications.

Original languageEnglish
Pages (from-to)270-274
Number of pages5
JournalTransplant International
Volume7
Issue numberS1
DOIs
Publication statusPublished - Dec 1994

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