The role of calcium-channel antagonists in solid organ transplantation.
Calcium-channel antagonists play a role not only in the management of cardiovascular disease, but they may also play a role in solid organ transplantation. Part of the success of solid organ transplantation over the last several years has been the development of potent immunosuppressive agents such as cyclosporine A and tacrolimus. The calcium-channel antagonists have been shown to decrease cyclosporine A-induced nephrotoxicity by blocking the vasoconstrictive effects of endothelin and thromboxane A2 on the afferent arteriole induced by this agent. The role of calcium antagonists in avoiding tacrolimus-induced nephrotoxicity has not been studied to date. Calcium antagonists have been shown to have an immune-modulating effect as well, via inhibition of calcium-mediated lymphocyte proliferation. This immune-modulating effect has resulted in a decreased incidence of acute rejection in those patients receiving concomitant cyclosporine and calcium antagonists. A third role for calcium antagonists in organ transplantation has been as an additive to organ preservation solutions to avoid calcium-mediated ischemic damage. Despite several successful investigations demonstrating a role for calcium antagonists in solid organ transplantation, widespread acceptance of such a role awaits larger randomized clinical trials.
Huntress
J D
JD
Department of Pharmacy, University of Rochester, NY 14642, USA.
Papadakos
P J
PJ
D000818:Animals; D002121:Calcium Channel Blockers / Q000494:pharmacology / Q000627:therapeutic use*; D016572:Cyclosporine / Q000009:adverse effects*; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007668:Kidney / Q000187:drug effects; D009926:Organ Preservation / Q000379:methods*; D016377:Organ Transplantation; D016559:Tacrolimus / Q000009:adverse effects*
D002121:Calcium Channel Blockers; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus