[Protective effect of the calcium antagonist diltiazem on acute kidney failure following kidney transplantation. The results of a prospective randomized study].
In a prospective randomised study the effect of the calcium antagonist diltiazem on primary transplant failure following cadaver kidney transplantation was studied. The transplants were perfused with a solution containing 20 mg/l diltiazem, the graft recipient received diltiazem as a bolus injection of 0.28 mg/kg pre-operatively, followed by a continuous infusion of 0.0022 mg/kg X min for 48 hours. Thereafter diltiazem was applied orally (twice 60 mg/d). Glomerular filtration rate and renal blood flow were measured by single-shot techniques (inulin, PAH). For immunosuppression ciclosporin A and low-dose methylprednisolone were given. Nine patients (41%) in the control group (n = 22) but only two (10%) in the diltiazem group (n = 20) developed primary transplant failure (P less than 0.05). Glomerular filtration rate in transplants with primary function was significantly higher in the diltiazem group (day 4: 29 +/- 0.8 vs. 20 +/- 0.8; day 7: 39 +/- 1.4 vs. 24.9 +/- 0.7 ml/min, P less than 0.05) although ciclosporin blood levels were significantly higher in this group (week 1: 1150 vs. 728 ng/ml, P less than 0.01). The rate of rejection episodes was significantly higher in controls than in patients on diltiazem (0.5 +/- 0.05 vs. 0.1 +/- 0.02 rejection episodes per patient in the first postoperative month, P less than 0.05).


CONCLUSIONS
Diltiazem has a protective effect against primary transplant failure following cadaver kidney transplantation. Furthermore, it might reduce the nephrotoxicity of ciclosporin A.
D058186:Acute Kidney Injury / Q000188:drug therapy*; D001552:Benzazepines / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D004110:Diltiazem / Q000627:therapeutic use*; D006084:Graft Rejection / Q000187:drug effects*; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D016030:Kidney Transplantation; D011183:Postoperative Complications / Q000188:drug therapy*; D011446:Prospective Studies; D011897:Random Allocation
D001552:Benzazepines; D004110:Diltiazem
Protektiver Einfluss des Calciumantagonisten Diltiazem auf das akute Nierenversagen nach Nierentransplantation. Ergebnisse einer prospektiven randomisierten Studie.