SO045FELODIPINE REDUCES DECLINE IN GLOMERULAR FILTRATION RATE IN LUNG TRANSPLANTED PATIENTS TREATED WITH CYCLOSPORINE: A RANDOMIZED PLACEBO CONTROLLED TRIAL

Abstract

Background. Calcium channel blockers may ameliorate the decline in renal function caused by calcineurin inhibitors in lung transplant (LTX) recipients. We previously demonstrated a 47 ml/min decline in glomerular filtration rate 12 weeks after LTX and a 22% incidence of ESRD after 10 years in LTX patients Methods. In this double-blind study we randomly assigned 41 patients with end stage lung disease and normal kidney function to receive placebo (20 patients) or felodipine (21 patients) started preoperatively and titrated to 10 mg or maximum tolerable dose. Only patients above the age of 18 and on the waiting list for pulmonary transplantation were eligible for inclusion. The primary endpoint was the change in renal function as measured by glomerular filtration rate using Cr-51 labelled ethylenediamine tetraacetic acid from transplantation to 12 weeks hereafter. Results. Treatment with felodipine resulted in a 35% lesser decrease in GFR compared to placebo (16.8 ml/min/1.73m2 (95% CI: 4.3-29.3 ml/min; 31.3+/-19.0 ml/min/1.73m2 and 48.1+/-18.4 ml/min/1.73m2 respectively, P=0.01)). Hypotension occurred more frequently among felodipine-treated patients compared with placebo (P<0.01). Blood pressure control assessed by systolic blood pressure at 3 weeks improved in patients treated with felodipine during the study period (P=0.048). Body weight did not differ significantly in the two groups during the study. Conclusions. Compared with placebo, felodipine ameliorated the initial decline in GFR caused by calcineurin inhibitors after lung transplantation.