Ingsathit Atiporn, Sumethkul Vasant, Chalermsanyakorn Panas, Jirasiritham Sophon
Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 2006 Aug;89 Suppl 2:S235-41.
Diltiazem and cyclosporin A (CsA) share a similar metabolism and degradation via the hepatic cytochrome p 450 subfamily 3A4. Co-administration of diltiazem with CsA may lead to CsA dosage reduction, blood pressure control and renal protection.
To study the four year outcome of kidney transplant recipients who received diltiazem administration with CsA. This was compared to the outcomes of patients who received CsA without diltiazem and were matched for blood pressure control and other baseline characteristics.
Forty eight patients were included in the diltiazem group and seventy patients in the non-diltiazem group. CsA monitoring was done by using trough level (monoclonal fluorescent polarization immunoassay).
The results showed that both groups has similar 4-year graft survival (92 and 95 %) with a similar mean final serum creatinine (1.3 mg/dl). Mean dose of CsA during the first month was 30 % lower in the diltiazem than non-diltiazem group. At one year CsA dose was 11% lower in the diltiazem than non-diltiazem group. However the diltiazem group was associated with significantly higher probability to have chronic allograft nephropathy than the non-diltiazem group (31% VS 19%) (RR 2.93; p = 0.03; Multivariate Cox regression).
Co administration of diltiazem with trough level adjusted CsA is associated with benefits in terms of CsA dose reduction and good graft survival and function. However there appeared to be no protective effect of diltiazem on the progression to chronic allograft nephropathy.
地尔硫䓬和环孢素A（CsA）通过肝细胞色素P450 3A4亚家族具有相似的代谢和降解过程。地尔硫䓬与CsA联合使用可能导致CsA剂量减少、血压控制和肾脏保护。
研究接受地尔硫䓬与CsA联合治疗的肾移植受者的四年结局。将其与接受CsA但未用地尔硫䓬且血压控制和其他基线特征相匹配的患者结局进行比较。
地尔硫䓬组纳入48例患者，非地尔硫䓬组纳入70例患者。通过谷值水平（单克隆荧光偏振免疫测定法）进行CsA监测。
结果显示，两组的4年移植物存活率相似（分别为92%和95%），平均最终血清肌酐水平相似（1.3mg/dl）。地尔硫䓬组第一个月的CsA平均剂量比非地尔硫䓬组低30%。在一年时，地尔硫䓬组的CsA剂量比非地尔硫䓬组低11%。然而，地尔硫䓬组发生慢性移植肾肾病的概率显著高于非地尔硫䓬组（31%对19%）（风险比2.93；p = 0.03；多变量Cox回归）。
地尔硫䓬与根据谷值水平调整的CsA联合使用在CsA剂量减少以及良好的移植物存活和功能方面具有益处。然而，地尔硫䓬对慢性移植肾肾病进展似乎没有保护作用。
