Does Diltiazem Provide Benefits on Allograft Functions in Kidney Transplant Recipients?

Yıl 2020, Cilt: 17 Sayı: 3, 425 - 430, 25.12.2020

Mehmet Emin Demir , Özgür Merhametsiz , Murathan Uyar , Murat Sevmis , Sema Aktas , Şinasi Sevmiş

https://doi.org/10.35440/hutfd.815458

Öz

Background: Acute and chronic calcineurin inhibitors (CNI) nephrotoxicity is a common concern in kidney transplant (KT) recipients. It is unclear whether diltiazem use can reduce CNI induced acute and chronic nephrotoxicity in (KT) recipients. In this study, we investigated the impact of diltiazem on 1 –year allograft survival and function.
Materials and Methods: This single-center retrospective study included 312 kidney transplant recipients and donors. Diltiazem receiving and diltiazem-free recipients were compared for 1-year allograft survival and functions. Available allograft biopsies were investigated for the evidence pieces of CNI induced nephrotoxicity. Factors may have a potential impact on allograft functions were evaluated (cytomegalovirus and polyoma BK viremia positivity, acute rejection episodes, donors and recipients ages and body mass indexes). A statistical package program was used for data analysis. P<0.05 was assigned significant.
Results: Seventy-three recipients in diltiazem arm and 239 in diltiazem-free arm were compared. In diltiazem and diltiazem-free arms, 1- year mortality, allograft survival rates and CNI induced nephrotoxicity incidences were 4.1% vs 3.8% (P=0.89), and 13.7% vs 7.1% (P=0.08), 18.8% vs 10.5% (P=0.27), respectively. However, 12-month estimated glomerular filtration rate was worse in diltiazem arm (62.75 ml/dk/1.73m2) compared to diltiazem-free group (73.19 ml/dk/1.73m2) (P=0.03). CNI toxicity had a weak impact on low eGFR in regression analysis (P=0.055 and 95% confidence interval).
Conclusions: Despite diltiazem use allows to CNI dose reduction, it might have undesirable impacts on long-term allograft functions, which is the main target of the allograft care.

Key Words: Allograft function, Diltiazem, Kidney transplantation

Anahtar Kelimeler

Allograft survival, Diltiazem, Kidney transplantation

Diltiazem Böbrek Alıcılarında Greft Fonksiyonlarını İyileştirir mi?

Öz

Amaç: Akut ve kronik kalsinörin inhibitörü (KNİ) toksisitesi böbrek naklinde önemli bir sorundur. Diltiazem kullanımının KNİ toksisitesini azaltıp azaltmadığı net değildir. Bu çalışmada KNİ kullanımının 1 yıllık greft sağkalımı ve fonksiyonu üzerine etkilerini araştırdık.
Materyal ve Metod: Bu tek merkezli retrospektif çalışmada 312 böbrek alıcısı ve vericisi incelendi. Alıcılar diltiazem kullanan ve kullanmayan guruplar olarak ikiye ayrıldı. 1 yıllık alıcı ve greft sağkalımları araştırıldı. Greft biyopsilerinde KNİ toksisitesi ile 1 yıllık greft sağ kalımı arasındaki ilişki incelendi. Sitomegalovirüs ve polyoma BK virüs viremisi varlığı, akut rejeksiyon atakları, alıcı ve vericinin yaşları ve vücut kitle indekslerinin 1 yıllık greft sağ kalımı üzerine etkileri araştırıldı. Veriler bir istatistik paket programda değerlendirildi, P<0,05 anlamlı kabul edildi.
Bulgular: Alıcıların 73’ü diltiazem kullandı, 239’u diltiazem kullanmadı. 1 yıllık mortalite, greft sağ kalımı, Kalsinörin inhibitörü ilişkili nefrotoksisite diltiazem kolunda ve diltiazem kullanmayan gurupta sırasıyla; %4,1 e karşı %3,8 (P=0,89), %13,7’ye karşı %7,1 (P=0.08) ve %18,8’e karşı %10,5 (P=0,27) idi. 12 ay sonunda tahmini glomerüler filtrasyon hızı diltiazem kolunda daha kötü idi; 62,75 ml/dk/1.73m2’ye karşı 73,19 ml/dk/1,73m2 (P=0.03). Kalsinörin inhibitörü toksisitesinin kötü greft fonksiyonları üzerine %95 güven aralığında zayıf bir etkisi görüldü (P=0.055).
Sonuç: Diltiazem KNİ doz azaltımına imkân sağlasa da esasen istenen uzun dönem greft fonksiyonları üzerine olumsuz etkilere sahip olabilir.

Anahtar Kelimeler

Böbrek Nakli, Diltiazem, Greft sağkalımı

Kaynakça

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