Nicardipine As Antihypertensive Therapy in Liver Transplant Recipients: Results of Long–Term Use

Abstract

antihypertensive therapy. 6 Nicardipine, a 1-4 dihydropyriArterial hypertension is frequent in liver transplant dine CCB efficient to control arterial hypertension 7,8 is availrecipients on cyclosporine A (CsA). Nicardipine is a calable in an intravenous form which makes its use very convecium channel blocker (CCB) that has been shown to nient in the immediate postoperative period. 9,10 However, be efficient in controlling postoperative hypertension.some reports point out interactions of nicardipine with CsA However, its use has been limited in organ recipients metabolism in renal transplant recipients 11-13 with a possibecause of its reported interaction with CsA metaboble enhanced CsA toxicity. Therefore, caution is recomlism. In this report, we studied the results of the longmended when using nicardipine in these patients, 12 and it term use of nicardipine after liver transplantation.has been proposed to avoid this drug in organ transplant Forty-nine consecutive liver transplant recipients with recipients. In our liver transplant unit, we chose to use nia follow-up longer than 2 years were studied. Immunocardipine as part of the regular postoperative, antihypertensuppressive regimen was based on CsA and prednisone.sive program because of its convenience. The aim of this Patients with immediate postoperative hypertenstudy is to report our experience of the post-LT, long-term sion received intravenous nicardipine, secondarily use of this drug. switched to oral nicardipine (group 1, n Å 27). Patients with delayed hypertension (i.e., ú2 weeks posttrans- PATIENTS AND METHODS plant) received other antihypertensive drugs which didA study was made of 61 consecutive liver transplantation recipinot interact with CsA metabolism. These patients and ents who had completed a posttransplantation follow-up longer than those without hypertension formed group 2 (n Å 22).two years. Twelve patients were excluded from the analysis becauseThe two groups were similar for age, sex, body weight, of an immunosuppressive regimen other than CsA (FK 506) in three and transplantation indications. Interaction of nicar-cases, an associated enzyme-inducer treatment in three cases, comdipine with CsA metabolism was confirmed. Whereas bined liver-kidney transplant in four cases, and malabsorption in cyclosporine blood levels were similar in both groups two cases. Overall, 49 patients were evaluated as the basis of this at any time during the study, the mean cyclosporine report.The induction immunosuppressive regimen that we used was predaily dose required to achieve such levels was 30% viously reported.14 Briefly, when serum creatinine at postoperative lower in group 1 compared with group 2 (P õ .01). This (LT) has allowed considerable improvement in long-term Arterial hypertension was defined by an increase in systemic results of this procedure. 1,2 However, CsA administration is blood pressure above 160/95 mmHg. 15 Postoperative management associated with a 50% to 75% incidence of arterial hyperten-of hypertension was designed as follows. (...

Posttransplantation care: Role of the primary care physician versus transplant center

“…If hypertension persists, vasodilator treatment with calcium channel blockers is preferred because of its counteractive effects on vasoconstriction and possible reduced nephrotoxicity. 34 Amlodipine is our favored agent secondary to its lack of interactions with calcineurin inhibitors. Diltiazem and verapamil are avoided because they alter cyclosporine and tacrolimus levels.…”