EFFECT OF NIFEDIPINE ON RENAL-ALLOGRAFT FUNCTION AND SURVIVAL BEYOND ONE-YEAR

We previously reported that a calcium channel blocker supplemented imm unosuppression 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 immunosuppres sion as compared with those of historical controls who were treated si milarly without nifedipine. Study subjects included 111 patients trans planted in 1990-1994, treated with nifedipine and triple immunosuppres sion and with functioning grafts for more than one year (Nifedipine gr oup). The results of cyclosporine (CyA) dose, blood pressure (BP), ser um creatinine (Cr), and actuarial graft survival rate (GSR) up to 5 ye ars posttransplant in these patients were compared with those of 52 pa tients transplanted in 1985-1990, treated similarly without calcium ch annel blockers (Control group). Donor sources, gender ratio, age distr ibution, causes of end stage renal disease, incidence of hyper tension prior to transplantation and incidence of rejection in the first year between the groups were comparable. Throughout the study period the N ifedipine 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 Cont rol group. BP was comparable despite higher CyA doses in the Nifedipin e group (4.3 +/- 1.1 vs. 3.3 +/- 1.1 mg/kg/day). We conclude that nife dipine is beneficial in improving long-term graft function and surviva l in kidney transplant recipients by mitigating CyA associated renal i njury.