Shin G T, Cheigh J S, Riggio R R, Suthanthiran M, Stubenbord W T, Serur D, Wang J C, Rubin A L, Stenzel K H
Rogosin Institute, New York, NY, USA.
Clin Nephrol. 1997 Jan;47(1):33-6.
We previously reported that a calcium channel blocker supplemented immunosuppression produced excellent patient and graft survival rates in cadaveric kidney transplantation. We report here the long term outcome of patients treated with nifedipine-supplemented triple immunosuppression as compared with those of historical controls who were treated similarly without nifedipine. Study subjects included 111 patients transplanted in 1990-1994, treated with nifedipine and triple immunosuppression and with functioning grafts for more than one year (Nifedipine group). The results of cyclosporine (CyA) dose, blood pressure (BP), serum creatinine (Cr), and actuarial graft survival rate (GSR) up to 5 years posttransplant in these patients were compared with those of 52 patients transplanted in 1985-1990, treated similarly without calcium channel blockers (Control group). Donor sources, gender ratio, age distribution, causes of end stage renal disease, incidence of hypertension prior to transplantation and incidence of rejection in the first year between the groups were comparable. Throughout the study period the Nifedipine group had significantly lower serum Cr (1.5 +/- 0.7 vs. 1.8 +/- 0.7 mg/dl) and higher GSR (93.8% vs. 88% at 5 years) than the Control group. BP was comparable despite higher CyA doses in the Nifedipine group (4.3 +/- 1.1 vs. 3.3 +/- 1.1 mg/kg/day). We conclude that nifedipine is beneficial in improving long-term graft function and survival in kidney transplant recipients by mitigating CyA associated renal injury.
我们之前报道过，在尸体肾移植中，补充钙通道阻滞剂的免疫抑制方案可使患者和移植物的存活率达到优异水平。在此，我们报告硝苯地平补充三联免疫抑制治疗患者的长期结果，并与未使用硝苯地平、接受类似治疗的历史对照患者进行比较。研究对象包括1990年至1994年接受移植的111例患者，他们接受了硝苯地平和三联免疫抑制治疗，且移植肾功能良好超过一年（硝苯地平组）。将这些患者移植后长达5年的环孢素（CyA）剂量、血压（BP）、血清肌酐（Cr）以及精算移植存活率（GSR）结果，与1985年至1990年接受移植的52例患者进行比较，这些患者接受了类似治疗但未使用钙通道阻滞剂（对照组）。两组之间的供体来源、性别比例、年龄分布、终末期肾病病因、移植前高血压发病率以及第一年排斥反应发生率具有可比性。在整个研究期间，硝苯地平组的血清Cr显著低于对照组（1.5±0.7 vs. 1.8±0.7 mg/dl），5年时的GSR高于对照组（93.8% vs. 88%）。尽管硝苯地平组的CyA剂量较高（4.3±1.1 vs. 3.3±1.1 mg/kg/天），但其血压与对照组相当。我们得出结论，硝苯地平通过减轻与CyA相关的肾损伤，有助于改善肾移植受者的长期移植物功能和存活率。
