Impact of diltiazem administration and cyclosporine levels on the incidence of acute rejection in heart transplant patients.
To identify the clinical factors associated with acute rejection (AR) in the first year after heart transplantation (HT), we analysed 112 patients. All patients received OKT3 and standard triple-drug therapy. We analysed the following variables to determine their relationship with AR: age and gender, panel-reactive antibodies, HLA-DR mismatch, use of Sandimmune vs Neoral, diltiazem administration, and cyclosporine levels in week 2 and months 1, 2, and 3 after HT. Fifty-two patients had no AR and 49 had at least one episode. The variables independently associated with absence of AR were diltiazem administration (odds ratio 0.306, confidence limit 0.102-0.921) and cyclosporine level in the first month after HT (odds ratio 0.996, confidence limit 0.992-0.999). Furthermore, a cyclosporine level greater than 362 ng/ml in the first month predicted the absence of AR. In conclusion, a cyclosporine level greater than 362 ng/ml and diltiazem administration in the first month after HT reduce AR during the first year. Both cyclosporine level and diltiazem show a large and independent protective effect.
Delgado
Juan F
JF
Heart Failure and Transplant Unit, Cardiology Department, Hospital Doce de Octubre, Ctra. de Andalucía, Km 5,400, 28041, Madrid, Spain, fdelgadoj@meditex.es
Sánchez
Violeta
V
de la Calzada
Carlos S
CS
Gómez-Sánchez
Miguel A
MA
Escribano
Pilar
P
Cea-Calvo
Luis
L
Pascual
Jacinto García
JG
de la Cámara
Agustín Gómez
AG
Sotelo
Teresa
T
Rufilanchas
Juan J
JJ
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D016572:Cyclosporine / Q000097:blood*; D004110:Diltiazem / Q000627:therapeutic use*; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000097:blood*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012307:Risk Factors; D013997:Time Factors
D000959:Antihypertensive Agents; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D004110:Diltiazem