Impact of diltiazem administration and cyclosporine levels on the incidence of acute rejection in heart transplant patients

Abstract

To identify the clinical factors associated with acute rejection (AR) in the first year after heart transplantation (HT), we analysed 112 patients. All patients received OKT3 and standard triple-drug therapy. We analysed the following variables to determine their relationship with AR: age and gender, panel-reactive antibodies, HLA-DR mismatch, use of Sandimmune vs Neoral, diltiazem administration, and cyclosporine levels in week 2 and months 1, 2, and 3 after HT. Fifty-two patients had no AR and 49 had at least one episode. The variables independently associated with absence of AR were diltiazem administration (odds ratio 0.306, confidence limit 0.102-0.921) and cyclosporine level in the first month after HT (odds ratio 0.996, confidence limit 0.992-0.999). Furthermore, a cyclosporine level greater than 362 ng/ml in the first month predicted the absence of AR. In conclusion, a cyclosporine level greater than 362 ng/ml and diltiazem administration in the first month after HT reduce AR during the first year. Both cyclosporine level and diltiazem show a large and independent protective effect.

Combination use of immune complexes and a Ca2+ channel blocker azelnidipine enhances interleukin-12 p40 secretion without T helper type 17 cytokine secretion in human monocyte-derived dendritic cells

“…The mechanism has been explained by the finding that diltiazem increases the blood concentration of CyA by inhibiting CyA metabolism in hepatic cytochrome P450 enzymes [45][46][47]. However, our results showed that a Ca2 + channel blocker enhanced IL-12 p40 secretion from MDDCs.…”

Influence of cytomegalovirus infection in the development of cardiac allograft vasculopathy after heart transplantation

“…31 Previous studies have reported that diltiazem slows the development of CAV 32 and reduces the incidence of acute rejection. [33][34][35] Moreover, studies with heterotopic HTx models have shown that diltiazem exerts immunosuppressive and immunomodulating effects. Transmembrane calcium movement plays a critical role in lymphocyte function, and numerous investigators have demonstrated that diltiazem inhibits lymphocyte functions and depresses the immune response.…”

Should We Consider Heart Rate Reduction in Cardiac Transplant Recipients?

“…In another study, clinical factors associated with acute rejection in the first year after heart transplantation were analyzed in 112 HTX recipients. 37 The result from this study showed that diltiazem administration and cyclosporine level in the first month after HT were both independently associated with the absence of acute rejection. Both diltiazem and cyclosporine level showed a large and independent protective effect.…”