Influence of diltiazem on renal function and rejection in renal allograft recipients receiving triple-drug immunosuppression: a randomized, double-blind, placebo-controlled study

In a prospective, randomized and placebocontrolled study weevaluated the influence of treatment with the calcium-channelblocker diltiazem on the course and results of cadaveric kidneytransplantation in 39 graft recipients. The grafts were reperfusedwith Euro-Collins solution containing diltiazem 20 mg/l. Allrecipients except those in chronic treatment with a calcium-channelblocker received preoperatively a bolus of diltiazem or placebo0.3 mg/kg and in all an infusion of diltiazem or placebo 3 mg/kg/24h was started preoperatively. After that, diltiazem or placebowas given orally for 3 months. Donors were not treated. Immunosuppressivetherapy consisted of prednisone, azathioprine and CsA. Therewere no significant differences between the groups concerningdonor or recipient characteristics, HLA-mismatching, and ischaemictime. Thrombosis leading to graft loss occurred in 3 recipients(diltiazem:2, placebo:1) and one graft was lost due to septicaemia(diltiazem). For the remaining 35 grafts no beneficial effectof treatment with diltiazem was found for the rate of delayedgraft function, the rate of rejections, time to first rejection,whole blood CsA concentration, or graft function. The CsA doseneeded to reach target whole blood concentration was significantlyless in the diltiazem group. In conclusion, our results do notindicate any beneficial effects of treatment with diltiazemin cadaveric kidney transplantation, except a reduction of costsbecause of a significant reduction of the CsA dosage.