title: Impact of diltiazem administration and cyclosporine levels on the incidence of acute rejection in heart transplant patients.
abstract: 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.
authors.affiliation: Heart Failure and Transplant Unit, Cardiology Department, Hospital Doce de Octubre, Ctra. de Andalucía, Km 5,400, 28041, Madrid, Spain, fdelgadoj@meditex.es
authors.forename: Juan F
authors.initials: JF
authors.lastname: Delgado
authors.forename: Violeta
authors.initials: V
authors.lastname: Sánchez
authors.forename: Carlos S
authors.initials: CS
authors.lastname: de la Calzada
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Gómez-Sánchez
authors.forename: Pilar
authors.initials: P
authors.lastname: Escribano
authors.forename: Luis
authors.initials: L
authors.lastname: Cea-Calvo
authors.forename: Jacinto García
authors.initials: JG
authors.lastname: Pascual
authors.forename: Agustín Gómez
authors.initials: AG
authors.lastname: de la Cámara
authors.forename: Teresa
authors.initials: T
authors.lastname: Sotelo
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Rufilanchas
mesh_terms: 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
chemical_list: D000959:Antihypertensive Agents; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D004110:Diltiazem