دورية أكاديمية
Diltiazem as a cyclosporine A-sparing agent in heart transplantation: Benefits beyond dose reduction.
| العنوان: | Diltiazem as a cyclosporine A-sparing agent in heart transplantation: Benefits beyond dose reduction. |
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| المؤلفون: | Alyaydin E; Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Muenster, Germany., Reinecke H; Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Muenster, Germany., Tuleta I; Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Muenster, Germany., Sindermann JR; Interdisciplinary Heart Failure Section, University Hospital Muenster, Muenster, Germany. |
| المصدر: | Medicine [Medicine (Baltimore)] 2022 Oct 14; Vol. 101 (41), pp. e31166. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 2985248R Publication Model: Print Cited Medium: Internet ISSN: 1536-5964 (Electronic) Linking ISSN: 00257974 NLM ISO Abbreviation: Medicine (Baltimore) Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Hagerstown, Md : Lippincott Williams & Wilkins |
| مواضيع طبية MeSH: | Cyclosporine*/therapeutic use , Heart Transplantation*/adverse effects, Adult ; Calcineurin Inhibitors/therapeutic use ; Diltiazem/therapeutic use ; Drug Tapering ; Graft Rejection/prevention & control ; Humans ; Immunosuppressive Agents/therapeutic use ; Mycophenolic Acid/therapeutic use ; Retrospective Studies |
| مستخلص: | Diltiazem (DZ) is widely prescribed in transplant recipients because of its drug-drug interactions with calcineurin inhibitors (CNI). However, these interactions have been primarily investigated in renal transplantation, and data regarding the long-term efficacy and safety of DZ in orthotopic heart transplantation (OHT) are still sparse. Our study aimed to elucidate the extent to which the co-prescription of DZ reduces the dose required to maintain adequate blood levels of cyclosporine A (CsA) and the resulting effect on morbidity and mortality in OHT recipients. We performed a retrospective single-center analysis of OHT recipients on a long-term immunosuppressive regimen based on CsA and mycophenolate mofetil (MMF). The study population consisted of 95 adult OHT recipients with a mean follow-up of 15.8 ± 6.7 years. DZ was co-prescribed in 39 subjects (41.1%) and was associated with a 28.6% reduction of the mean CsA daily dose (P < .001). Patients on DZ had less frequent rejection episodes (P = .002), better renal function (P = .009) and a lower rate of end-stage renal disease (P = .008). Additionally, they developed later cardiac allograft vasculopathy (CAV). We observed no prognostic relevance of DZ co-prescription in univariate and multivariate Cox-regression analyses. In addition to reducing the CsA dose required to maintain adequate blood through levels, DZ may have nephroprotective properties in OHT. The co-administration of DZ may decelerate the development of CAV and reduce the frequency of the rejection episodes. However, the beneficial influence on morbidity has no impact on mortality. Competing Interests: The authors have no funding and conflicts of interest to disclose. (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.) |
| References: | Brink JG, Hassoulas J. The first human heart transplant and further advances in cardiac transplantation at Groote Schuur Hospital and the University of Cape Town - with reference to: the operation. A human cardiac transplant: an interim report of a successful operation performed at Groote Schuur Hospital, Cape Town. Cardiovasc J Afr. 2009;20:31–5. Sivathasan C. Experience with cyclosporine in heart transplantation. Transplant Proc. 2004;36(2 Suppl):346S–8S. Azzi JR, Sayegh MH, Mallat SG. Calcineurin inhibitors: 40 years later, can’t live without. J Immunol. 2013;191:5785–91. Xue W, Song Y, Tian P, et al. The effects of diltiazem in renal transplantation patients treated with cyclosporine A. J Biomed Res. 2010;24:317–23. Schroeder JS, Gao SZ, Alderman EL, et al. A preliminary study of diltiazem in the prevention of coronary artery disease in heart-transplant recipients. N Engl J Med. 1993;328:164–70. Xue W, Ding X, Tian P, et al. Long-term follow-up of co-administration of diltiazem and cyclosporine in Chinese kidney transplant recipients. Ren Fail. 2010;32:314–9. Hermann M, Enseleit F, Fisler AE, et al. Cyclosporine C0- versus C2-monitoring over three years in maintenance heart transplantation. Swiss Med Wkly. 2011;141:w13149. Rodrigo E, Ruiz JC, Angeles de Cos M, et al. Correlation of C0 and C2 levels with cyclosporine side effects in kidney transplantation. Transplant Proc. 2009;41:2328–31. Serón D, Moreso F. Preservation of renal function during maintenance therapy with cyclosporine. Transplant Proc. 2004;36(2 Suppl):257S–60S. Mehra MR, Crespo-Leiro MG, Dipchand A, et al. International Society for Heart and Lung Transplantation working formulation of a standardized nomenclature for cardiac allograft vasculopathy-2010. J Heart Lung Transplant. 2010;29:717–27. Hickey KT, Doering LV, Chen B, et al. Clinical and gender differences in heart transplant recipients in the NEW HEART study. Eur J Cardiovasc Nurs. 2017;16:222–9. Jones TE, Morris RG, Mathew TH. Diltiazem-cyclosporin pharmacokinetic interaction – dose-response relationship. Br J Clin Pharmacol. 1997;44:499–504. Alyaydin E, Welp H, Reinecke H, et al. Predisposing factors for late mortality in heart transplant patients. Cardiol J. 2021;28:746–57. Alyaydin E, Pogoda C, Dell Aquila A, et al. Cardiac allograft vasculopathy in a long-term follow-up after heart transplantation: Role of remnant cholesterol in residual inflammation. Cardiol J. 2022;29:782–90. Jäämaa-Holmberg S, Salmela B, Lemström K, et al. Cancer incidence and mortality after heart transplantation - A population-based national cohort study. Acta Oncol. 2019;58:859–63. Van Keer J, Droogné W, Van Cleemput J, et al. Cancer after heart transplantation: a 25-year single-center perspective. Transplant Proc. 2016;48:2172–7. Chanard J, Toupance O, Lavaud S, et al. Amlodipine reduces cyclosporin-induced hyperuricaemia in hypertensive renal transplant recipients. Nephrol Dial Transplant. 2003;18:2147–53. Toupance O, Lavaud S, Canivet E, et al. Antihypertensive effect of amlodipine and lack of interference with cyclosporine metabolism in renal transplant recipients. Hypertension. 1994;24:297–300. Lam S, Partovi N, Ting LS, et al. Corticosteroid interactions with cyclosporine, tacrolimus, mycophenolate, and sirolimus: fact or fiction? Ann Pharmacother. 2008;42:1037–47. |
| المشرفين على المادة: | 0 (Calcineurin Inhibitors) 0 (Immunosuppressive Agents) 83HN0GTJ6D (Cyclosporine) EE92BBP03H (Diltiazem) HU9DX48N0T (Mycophenolic Acid) |
| تواريخ الأحداث: | Date Created: 20221018 Date Completed: 20221019 Latest Revision: 20221115 |
| رمز التحديث: | 20231215 |
| مُعرف محوري في PubMed: | PMC9575791 |
| DOI: | 10.1097/MD.0000000000031166 |
| PMID: | 36254022 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1536-5964 |
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| DOI: | 10.1097/MD.0000000000031166 |