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Prevention of delayed graft function in cadaver kidney transplants by diltiazem: outcome of two prospective,
1Department of Nephrology, Klinikum Steglitz, Freie Universität, Berlin, F.R.G.
Abstract:
Calcium entry blockers have a protective effect on experimental postischemic acute renal failure (ARF). Since delayed graft function (DGF) in cadaver kidney transplants is in part due to an ischemic damage to the kidney, we initiated two prospective, randomized clinical trials of human kidney transplants. Study I (control: n = 22; diltiazem: n = 20): Diltiazem (D) was added to Eurocollin's solution at a dose of 20 mg/l. If the donor had been treated with D, the graft recipient got a bolus injection of 0.28 mg/kg D and a continuous infusion of 0.002 mg/min/kg D for the first two days. A dose of 60 mg D was then given orally twice daily. Study II (control: n = 11; diltiazem: n = 10): We used the same regimen without donor pretreatment. All patients had immunosuppression with cyclosporine A (CsA) and low-dose steroids. Primary graft function (PGF) was defined as vital kidney function without hemodialysis (HD) during the first week. In both studies the incidence of PGF was higher in the D groups (I: 90% vs. 59%, p less than 0.05; II: 70% vs. 55%). In the control groups, 3.6 +/- 0.4 (I) and 4.9 +/- 0.7 (II) HD per patient was necessary, compared to 0.6 +/- 0.2 (I), p less than 0.05) and 1.9 +/- 0.4 (II) HD in the treatment groups.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Diltiazem administration improved primary graft function in kidney transplant recipients, reducing the need for hemodialysis. This calcium entry blocker shows promise in preventing delayed graft function after ischemia.
Area of Science:
- Nephrology
- Transplantation Immunology
- Cardiovascular Pharmacology
Background:
- Calcium entry blockers demonstrate protective effects against experimental postischemic acute renal failure (ARF).
- Delayed graft function (DGF) in cadaver kidney transplants is partly attributed to ischemic kidney damage.
Purpose of the Study:
- To evaluate the efficacy of diltiazem in preventing delayed graft function (DGF) in human kidney transplant recipients.
- To assess the impact of diltiazem on primary graft function (PGF) and the requirement for hemodialysis (HD).
Main Methods:
- Two prospective, randomized clinical trials were conducted involving cadaver kidney transplants.
- Study I involved donor pretreatment with diltiazem; Study II did not. Both used diltiazem in the recipient.
- Patients received immunosuppression with cyclosporine A (CsA) and low-dose steroids.
Main Results:
- The incidence of primary graft function (PGF) was significantly higher in the diltiazem groups compared to controls (Study I: 90% vs. 59%; Study II: 70% vs. 55%).
- Hemodialysis (HD) requirements were substantially reduced in patients receiving diltiazem (Study I: 0.6 vs. 3.6 sessions; Study II: 1.9 vs. 4.9 sessions).
Conclusions:
- Diltiazem administration, with or without donor pretreatment, improves early kidney graft function after transplantation.
- This calcium entry blocker effectively reduces the incidence of delayed graft function and the need for hemodialysis in kidney transplant recipients.
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01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure
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