BACKGROUND: Diabetic recipients of kidney transplants have an excessively high risk of allograft loss, infectious complications with sepsis, cardiovascular events and early death. This study was designed in order to determine whether post-transplantation medical management influenced long-term results. METHODS: Seventy consecutive diabetic recipients of cadaveric renal allografts were followed from the time of transplant. Treatment regimens were based on the clinical judgement of transplant nephrologists and surgeons, not by the study team. Patients were followed for 2 to 9 years (mean follow-up of 50.85 months, one lost to follow-up). Groups were classified by HLA match, type of immunosuppression, prior cardiovascular history, type of antihypertensives (36 on calcium channel blockers, 32 on beta blockers, 8 ACE inhibitors). Events were defined as myocardial infarction, CVA, graft loss with return to dialysis, life-threatening sepsis, or death. RESULTS: Twenty allografts failed during the study, 24 patients died. Potentially cardioprotective drugs did not impact significantly on cardiac death, MI or CVA. Survivals were better when calcium channel blockers were used (mean 71.7 vs 38.6 months, p < 0.05; 4-year survival 84 vs 58%). When both beta and calcium channel blockers were used (n = 20), patients mean survival was 72.5 months vs 36.8 months for 21 patients who were not treated with blockers (p < 0.005). There was a lower incidence of graft loss when beta blockers and calcium channel blockers were used: at mean patient survival of 36.8 months, the no-blockers group had a mean graft survival of 19.3 months vs 72.5 months for blocker-treated patients (p < 0.002). Reinstitution of dialysis occurred less often with calcium channel blockers (17 vs 42%) or beta blockers (19 vs 38%) used either individually or together (5 vs 42%), all p < 0.05. Calcium channel blocker treated patients had 1/9 the number of septic deaths, fewer patients had multiple septic episodes, all p < 0.02. CONCLUSION: Allograft success and patient survivals may be improved and sepsis related events diminished when diabetic renal allograft recipients are treated with calcium channel blocking agents, plus or minus beta blockers. Considerable savings can be accomplished and graft results with these drugs can approach non-diabetic and live-related transplant results.
BACKGROUND:Diabetic recipients of kidney transplants have an excessively high risk of allograft loss, infectious complications with sepsis, cardiovascular events and early death. This study was designed in order to determine whether post-transplantation medical management influenced long-term results. METHODS: Seventy consecutive diabetic recipients of cadaveric renal allografts were followed from the time of transplant. Treatment regimens were based on the clinical judgement of transplant nephrologists and surgeons, not by the study team. Patients were followed for 2 to 9 years (mean follow-up of 50.85 months, one lost to follow-up). Groups were classified by HLA match, type of immunosuppression, prior cardiovascular history, type of antihypertensives (36 on calcium channel blockers, 32 on beta blockers, 8 ACE inhibitors). Events were defined as myocardial infarction, CVA, graft loss with return to dialysis, life-threatening sepsis, or death. RESULTS: Twenty allografts failed during the study, 24 patients died. Potentially cardioprotective drugs did not impact significantly on cardiac death, MI or CVA. Survivals were better when calcium channel blockers were used (mean 71.7 vs 38.6 months, p < 0.05; 4-year survival 84 vs 58%). When both beta and calcium channel blockers were used (n = 20), patients mean survival was 72.5 months vs 36.8 months for 21 patients who were not treated with blockers (p < 0.005). There was a lower incidence of graft loss when beta blockers and calcium channel blockers were used: at mean patient survival of 36.8 months, the no-blockers group had a mean graft survival of 19.3 months vs 72.5 months for blocker-treated patients (p < 0.002). Reinstitution of dialysis occurred less often with calcium channel blockers (17 vs 42%) or beta blockers (19 vs 38%) used either individually or together (5 vs 42%), all p < 0.05. Calcium channel blocker treated patients had 1/9 the number of septic deaths, fewer patients had multiple septic episodes, all p < 0.02. CONCLUSION: Allograft success and patient survivals may be improved and sepsis related events diminished when diabetic renal allograft recipients are treated with calcium channel blocking agents, plus or minus beta blockers. Considerable savings can be accomplished and graft results with these drugs can approach non-diabetic and live-related transplant results.
Authors: Larry A Weinrauch; Jiankang Liu; Brian Claggett; Peter V Finn; Matthew R Weir; John A D'Elia Journal: Int J Nephrol Renovasc Dis Date: 2017-12-22