TY - JOUR
T1 - Prophylactic isradipine treatment after kidney transpIantation
T2 - a prospective double‐blind placebo‐controlled randomized trial
AU - van den Dorpel, Marinus A.
AU - Zietse, Robert
AU - Weimar, Willem
AU - Ijzermans, J. N.M.
PY - 1994/12
Y1 - 1994/12
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=0028676649&partnerID=8YFLogxK
U2 - 10.1111/j.1432-2277.1994.tb01365.x
DO - 10.1111/j.1432-2277.1994.tb01365.x
M3 - Article
C2 - 11271223
AN - SCOPUS:0028676649
SN - 0934-0874
VL - 7
SP - 270
EP - 274
JO - Transplant International
JF - Transplant International
IS - S1
ER -