Calcium channel blockade and preservation of renal graft function in cyclosporine-treated recipients: a prospective randomized placebo-controlled 2-year study.
BACKGROUND
Studies have provided conflicting results as to the protective role of calcium channel blockers (CCB) in cyclosporine-treated patients with regard to blood pressure control and preservation of renal graft function. Lacidipine is a dihydropyridine CCB that possesses antioxidative, anti-atherosclerotic, and anti-adhesion properties and was shown to prevent cyclosporine-induced nephrotoxicity in a rat model.


METHODS
We conducted a multicenter prospective, randomized, placebo-controlled study in 131 de novo recipients of a cadaveric renal allograft on cyclosporine therapy. The aim of this 2-year study was to assess the effects of lacidipine on graft function (plasma iohexol clearance), renal plasma flow, anastomotic arterial blood flow, deterioration of renal function, blood pressure, acute rejection, and hospitalization rate.


RESULTS
A total of 118 recipients were available for intention-to-treat analysis on efficacy (lacidipine: n=59; placebo: n=59). Graft function assessed by serum creatinine concentration and glomerular filtration rate measured as plasma iohexol clearance, was persistently better in lacidipine-treated patients from 1 year onwards (respectively, P<0.01 and P<0.05). Renal plasma flow and anastomotic blood flow were not significantly higher in lacidipine-treated patients. Three patients on lacidipine therapy and four on placebo experienced treatment failure defined as an increase in serum creatinine from baseline of more than 60% (log-rank test: P=0.57). Study groups did not differ in acute rejection rate, trough blood cyclosporine concentrations, blood pressure, number of antihypertensive drugs, hospitalization rate, and adverse event rate.


CONCLUSIONS
The use of calcium channel blockers in cyclosporine-treated renal recipients results in a significantly better allograft function at 2 years and this effect is independent of blood pressure lowering.
Kuypers
D R J
DR
Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium. Dirk.Kuypers@uz.kuleuven.ac.be
Neumayer
H H
HH
Fritsche
L
L
Budde
K
K
Rodicio
J L
JL
Vanrenterghem
Y
Y
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001794:Blood Pressure; D002121:Calcium Channel Blockers / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D016572:Cyclosporine / Q000097:blood / Q000627:therapeutic use*; D004095:Dihydropyridines / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000097:blood / Q000627:therapeutic use*; D015994:Incidence; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology*; D016030:Kidney Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D010349:Patient Compliance; D010359:Patient Readmission; D010919:Placebos; D011446:Prospective Studies; D013997:Time Factors; D017211:Treatment Failure
D002121:Calcium Channel Blockers; D004095:Dihydropyridines; D007166:Immunosuppressive Agents; D010919:Placebos; C060285:lacidipine; D016572:Cyclosporine