Verapamil improves the outcome after cadaver renal transplantation

Ingemar Dawidson, Pal Rooth, Christopher Y Lu, Arthur I Sagalowsky, Ken Diller, Biff F Palmer, Paul Peters, Richard Risser, Zsolt Sandor, Frank Seney

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

Because of their favorable effects on renal hemodynamics, calcium antagonists may have a major role in the prevention and management of certain types of acute renal dysfunction. In fact, verapamil (VP) was shown to prevent cyclosporin A (CsA)-induced decreases in RBF in mice and in cadaver renal transplant (CRT) recipients. The study presented here of 59 cadaver renal transplant patients evaluates the outcome from perioperative treatment with VP (N= 30) administered intraoperatively into the renal artery (10 mg) followed by oral administration of 120 mg every 8 to 12 h for 14 days versus no drug (N = 29). Early immunosuppression included azathioprine, corticosteroids, and antilymphocyte globulin with subsequent overlapping with CsA on days 5 and 6. Actuarial graft survival at 1 yr was different when the two groups were compared (P < 0.05). Estimated graft survival at 1 yr for VP patients was 93.3 compared with 72.4% in control patients. The improved graft survival was most striking in repeat transplants with 90% graft survival at 1 yr for VP recipients versus 37.5% for controls. Compared with controls, VP recipients had significantly improved renal parenchymal diastolic blood flow velocities on the first day after surgery (7.8 versus 5.8 cm/s). By day 7, GFR were greater with VP (44 ± 29 mL/min) versus controls (28 ± 22 mL/min). Of VP patients, 67% (18 of 24) had GFR greater than 30 mL/min versus 33% (9 of 26) for control patients. Similarly, on the seventh day, 77% (21 of 30) of VP patients had serum creatinines less than 2.0 mg% versus 34% (10 of 29) for controls. This improved renal function occurred despite significantly higher CsA blood levels in VP recipients, 178 ± 107 versus 89 ± 46 ng/mL in controls. The incidence of delayed function was 10% (3 of 30) and 24% (7 of 29) for VP versus no drug. The improved outcome after cadaver renal transplantation from perioperative VP may be related to its cellular protection from ischemia, the preferential dilation of the afferent arteriole, elevated CsA blood levels, and inherent immunosuppressive properties. It is concluded that VP markedly improves the outcome of cadaver renal transplantation.

Original languageEnglish (US)
Pages (from-to)983-990
Number of pages8
JournalJournal of the American Society of Nephrology
Volume2
Issue number5
StatePublished - Nov 1991

Fingerprint

Verapamil
Cadaver
Kidney Transplantation
Graft Survival
Kidney
Cyclosporine
Transplants
Antilymphocyte Serum
Blood Flow Velocity
Azathioprine
Arterioles
Renal Artery
Immunosuppressive Agents
Ambulatory Surgical Procedures
Pharmaceutical Preparations
Immunosuppression
Oral Administration
Dilatation
Creatinine
Adrenal Cortex Hormones

Keywords

  • ATN
  • Calcium channel blocker
  • GFR
  • Graft survival
  • RBF

ASJC Scopus subject areas

  • Nephrology

Cite this

Verapamil improves the outcome after cadaver renal transplantation. / Dawidson, Ingemar; Rooth, Pal; Lu, Christopher Y; Sagalowsky, Arthur I; Diller, Ken; Palmer, Biff F; Peters, Paul; Risser, Richard; Sandor, Zsolt; Seney, Frank.

In: Journal of the American Society of Nephrology, Vol. 2, No. 5, 11.1991, p. 983-990.

Research output: Contribution to journalArticle

Dawidson, I, Rooth, P, Lu, CY, Sagalowsky, AI, Diller, K, Palmer, BF, Peters, P, Risser, R, Sandor, Z & Seney, F 1991, 'Verapamil improves the outcome after cadaver renal transplantation', Journal of the American Society of Nephrology, vol. 2, no. 5, pp. 983-990.
Dawidson, Ingemar ; Rooth, Pal ; Lu, Christopher Y ; Sagalowsky, Arthur I ; Diller, Ken ; Palmer, Biff F ; Peters, Paul ; Risser, Richard ; Sandor, Zsolt ; Seney, Frank. / Verapamil improves the outcome after cadaver renal transplantation. In: Journal of the American Society of Nephrology. 1991 ; Vol. 2, No. 5. pp. 983-990.
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