NICARDIPINE AS ANTIHYPERTENSIVE THERAPY IN LIVER-TRANSPLANT RECIPIENTS - RESULTS OF LONG-TERM USE

Arterial hypertension is frequent in liver transplant recipients on cy closporine A (CsA), Nicardipine is a calcium channel blocker (CCB) tha t has been shown to be efficient in controlling postoperative hyperten sion, However, its use has been limited in organ recipients because of its reported interaction with CsA metabolism, In this report, we stud ied the results of the longterm use of nicardipine after liver transpl antation. Forty-nine consecutive liver transplant recipients with a fo llow-up longer than 2-years were studied. Immunosuppressive regimen wa s based on CsA and prednisone, Patients with immediate postoperative h ypertension received intravenous nicardipine, secondarily switched to oral nicardipine (group 1, n = 27). Patients with delayed hypertension (i,e,, > 2 weeks posttransplant) received other antihypertensive drug s which did not interact with CsA metabolism, These patients and those without hypertension formed group 2 (n = 22), The two groups were sim ilar for age, sex, body weight, and transplantation indications, Inter action of nicardipine with CsA metabolism was confirmed, Whereas cyclo sporine blood levels were similar in both groups at any time during th e study, the mean cyclosporine daily dose required to achieve such lev els was 30% lower in group 1 compared with group 2 (P < .01), This res ulted in a significant cost-containment. The use of nicardipine was no t associated with an increased incidence of graft rejection or CsA tox icity episodes, The results in liver transplant recipients showed that nicardipine interacts with CsA metabolism, leading to a 30% reduction in CsA dose and does not increase the risk of CsA toxicity or graft r ejection, Nicardipine can be used safely for the treatment of arterial hypertension after liver transplantation with a potential cost-contai nment.