Carvedilol treatment of kidney graft recipients with chronic rejection

Carvedilol is an antihypertensive drug with properties that may be potentia lly beneficial for kidney graft recipients. The purpose of the study was to investigate if progression of an established chronic rejection may be atte nuated or reversed by carvedilol. An open, single-centre, phase II, pilot study, with a 2-yr follow-up, was p erformed in 25 kidney graft recipients with chronic rejection or accelerate d transplant atherosclerosis. Seventeen patients had stable graft function assessed by serum creatinine l evels. Eight patients withdrew from the study due to lack of efficacy (incr ease in serum creatinine 174-477 mu mol/L (46-191%) from the initial levels ). However, these patients had higher serum creatinine levels and proteinur ia already at the start of the study. Both systolic and diastolic blood pre ssure, as well as heart rate, were stable in all study patients. Low densit y lipoprotein (LDL)/high density lipoprotein (HDL) cholesterol ratio decrea sed from 4.7 +/- 1.9 at 1 month to 3.5 +/- 1.2 at 18 months (p < 0.05), and MDA plasma levels decreased from 0.714 +/- 0.119 to 0.493 +/- 0.073 mu mol /L after 3 months of carvedilol treatment (p < 0.05). No attenuation of pro gression of chronic graft rejection by carvedilol treatment was observed in the study. It is suggested that the process of chronic rejection could not be reversed by carvedilol because the patients included in the study alrea dy had severe morphological and functional changes of the graft. In conclusion, our study demonstrated that carvedilol provides a good contr ol of blood pressure in renal transplanted patients. Carvedilol treatment h ad a beneficial effect on lipid pattern and reduced lipid oxidation, but th ere was no obvious effect on progression of chronic rejection.