antihypertensive therapy. 6 Nicardipine, a 1-4 dihydropyri-Arterial 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][12][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 did
A 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 because
The 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 nicarcases, an associated enzyme-inducer treatment in three cases, com- dipine 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 pre-daily 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 day 1 was less than 150 mmol/L, CsA was started and administered resulted in a significant cost-containment. The use of by continuous infusion at the increasing dose of 1 to 5 mg/kg/d to nicardipine was not associated with an increased incireach a whole blood concentration plateau of 400 to 500 ng/mL (monodence of graft rejection or CsA toxicity episodes. The clonal radioimmunoassay) by postoperative day 3. Ciclosporine A results in liver transplant recipients showed that nicarwas given in association with methyl-prednisolone, tapered from 10 dipine interacts with CsA metabolism, leading to a 30% mg/kg/d to 0.3 mg/kg/d over 6 days, and azathioprine at 2 mg/kg/d reduction in CsA dose and does not increase the risk of intravenously. When postoperative serum creatinine at day 1 ex- CsA toxicity or graft rejection. Nicardipine can be used ceeded 150 mmol/L, CsA administration was held until recovery of renal function and replaced by a 10-day course of antithymocyte safely for the treatment of arterial hypertension after globulins (Institut Me ´rieux, Paris, France). Maintenance immuno-Abbreviations: CsA, ciclosporine A; LT, liver transplantation; CCB, calcium channel blocker. weeks post-transplant, who had adjusted, steady CsA blood levels From the 1 Service d'He ´patologie et de Gastroente ´rologie, the 2 Service de Chirurgie Ge ´ne ´-received other antihypertensive drugs orally that did not interact rale et Digestive, and the 3 Service d'Anesthe ´sie et de Re ´animation, Ho ˆpital Henri Mondor, with CsA metabolism. Initially, 34 patients received intravenous Cre ´teil, France.