Prevention of delayed graft function in cadaver kidney transplants by diltiazem: outcome of two prospective, randomized clinical trials.
Calcium entry blockers have a protective effect on experimental postischemic acute renal failure (ARF). Since delayed graft function (DGF) in cadaver kidney transplants is in part due to an ischemic damage to the kidney, we initiated two prospective, randomized clinical trials of human kidney transplants. Study I (control: n = 22; diltiazem: n = 20): Diltiazem (D) was added to Eurocollin's solution at a dose of 20 mg/l. If the donor had been treated with D, the graft recipient got a bolus injection of 0.28 mg/kg D and a continuous infusion of 0.002 mg/min/kg D for the first two days. A dose of 60 mg D was then given orally twice daily. Study II (control: n = 11; diltiazem: n = 10): We used the same regimen without donor pretreatment. All patients had immunosuppression with cyclosporine A (CsA) and low-dose steroids. Primary graft function (PGF) was defined as vital kidney function without hemodialysis (HD) during the first week. In both studies the incidence of PGF was higher in the D groups (I: 90% vs. 59%, p less than 0.05; II: 70% vs. 55%). In the control groups, 3.6 +/- 0.4 (I) and 4.9 +/- 0.7 (II) HD per patient was necessary, compared to 0.6 +/- 0.2 (I), p less than 0.05) and 1.9 +/- 0.4 (II) HD in the treatment groups.(ABSTRACT TRUNCATED AT 250 WORDS)
Neumayer
H H
HH
Department of Nephrology, Klinikum Steglitz, Freie Universität, Berlin, F.R.G.
Wagner
K
K
D058186:Acute Kidney Injury / Q000517:prevention & control*; D000328:Adult; D002102:Cadaver; D002986:Clinical Trials as Topic; D003524:Cyclosporins / Q000008:administration & dosage; D004110:Diltiazem / Q000627:therapeutic use*; D005919:Glomerular Filtration Rate; D006084:Graft Rejection; D006801:Humans; D016030:Kidney Transplantation; D007683:Kidney Tubular Necrosis, Acute / Q000503:physiopathology / Q000517:prevention & control*; D008775:Methylprednisolone / Q000008:administration & dosage; D011446:Prospective Studies; D011897:Random Allocation; D012079:Renal Circulation
D003524:Cyclosporins; D004110:Diltiazem; D008775:Methylprednisolone