Excellent outcome with a calcium channel blocker—supplemented immunosuppressive regimen in cadaveric renal transplantation: A potential strategy to avoid antibody induction protocols

Manikkam Suthanthiran, R. H. Haschemeyer, R. R. Riggio, C. Adubor, G. S. Friedman, J. S. Cheigh, J. C. Wang, M. Fotino, W. T. Stubenbord, S. D. Saal, K. H. Stenzel, A. L. Rubin

Research output: Contribution to journalArticle

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Abstract

Many transplant centers routinely utilize monoclonal antibody or polyclonal antibody based induction protocols in recipients of cadaver renal allografts. Given the potential complications associated with antibody-based immunosuppression regimens (e.g., CMV disease), we tested the hypothesis that a combination of a calcium antagonist and a triple drug protocol (cyclosporine + prednisone + azathioprine) would be an effective substitute for antibody-based induction protocols in ensuring excellent patient and graft survival rates. Our postulate was tested in a prospective study of 52 consecutive recipients of cadaver renal allografts (44 first, 5 second, and 3 third grafts) utilizing nifedipine as the first line calcium antagonist. Nifedipine was selected over verapamil or diltiazem due to its lack of interference with the metabolism of CsA. Some of the significant outcomes of our prospective trial were (A) a cumulative patient survival rate of 98.1% for the 52 recipients at 18 months posttransplantation; (B) a cumulative allograft survival rate of 92.1% for the 52 consecutive cadaver renal allografts at 18 months; (C) a cumulative allograft survival rate of 100% at 18 months for the 24 of 52 renal allografts without delayed graft function following transplantation; and (D) a cumulative allograft survival rate of 86% at 18 months for the 28 of 52 renal allografts with delayed graft function. Of the 4 of 52 who lost their grafts, 2 grafts were removed following discontinuation of immunosuppressive therapy while the remaining 2 had primary nonfunction; and (E) the lack of a requirement for monoclonal or polyclonal antibodies for the treatment of acute rejection episodes in this patient population. These gratifying results compare very favorably with (A) recent reports of the effects of long-term diltiazem therapy and of verapamil used in conjunction with an induction protocol that included Minnesota antilymphocyte globulin in recipients of cadaver renal allografts, and (B) the clinical outcome in many institutions with 0KT3/ATG/ALG induction protocols. Whereas the mechanisms involved in the excellent clinical outcome found with the calcium antagonist remain undefined, our results strongly argue for a prospective, randomized and controlled study in which a calcium antagonist - supplemented immunosuppressive regimen is compared with antibody-based induction protocols.

Original languageEnglish
Pages (from-to)1008-1013
Number of pages6
JournalTransplantation
Volume55
Issue number5
DOIs
Publication statusPublished - 1 Jan 1993
Externally publishedYes

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Calcium Channels
Immunosuppressive Agents
Kidney Transplantation
Allografts
Antibodies
Kidney
Cadaver
Survival Rate
Delayed Graft Function
Calcium
Transplants
Diltiazem
Nifedipine
Verapamil
Antilymphocyte Serum
Azathioprine
Graft Survival
Prednisone
Immunosuppression
Cyclosporine

ASJC Scopus subject areas

  • Transplantation

Cite this

Excellent outcome with a calcium channel blocker—supplemented immunosuppressive regimen in cadaveric renal transplantation : A potential strategy to avoid antibody induction protocols. / Suthanthiran, Manikkam; Haschemeyer, R. H.; Riggio, R. R.; Adubor, C.; Friedman, G. S.; Cheigh, J. S.; Wang, J. C.; Fotino, M.; Stubenbord, W. T.; Saal, S. D.; Stenzel, K. H.; Rubin, A. L.

In: Transplantation, Vol. 55, No. 5, 01.01.1993, p. 1008-1013.

Research output: Contribution to journalArticle

Suthanthiran, M, Haschemeyer, RH, Riggio, RR, Adubor, C, Friedman, GS, Cheigh, JS, Wang, JC, Fotino, M, Stubenbord, WT, Saal, SD, Stenzel, KH & Rubin, AL 1993, 'Excellent outcome with a calcium channel blocker—supplemented immunosuppressive regimen in cadaveric renal transplantation: A potential strategy to avoid antibody induction protocols', Transplantation, vol. 55, no. 5, pp. 1008-1013. https://doi.org/10.1097/00007890-199305000-00011
Suthanthiran, Manikkam ; Haschemeyer, R. H. ; Riggio, R. R. ; Adubor, C. ; Friedman, G. S. ; Cheigh, J. S. ; Wang, J. C. ; Fotino, M. ; Stubenbord, W. T. ; Saal, S. D. ; Stenzel, K. H. ; Rubin, A. L. / Excellent outcome with a calcium channel blocker—supplemented immunosuppressive regimen in cadaveric renal transplantation : A potential strategy to avoid antibody induction protocols. In: Transplantation. 1993 ; Vol. 55, No. 5. pp. 1008-1013.
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