Calcium channel blockers can reduce the death of tubular cells in the kidney after a transplant operation

Shilliday IR, Sherif M

Published Online:

January 21, 2009

Acute tubular necrosis (ATN) is the sudden death of tubular cells in the kidney. ATN can happen after a kidney transplant if the kidney does not receive enough oxygen. Calcium channel blockers stop calcium ions flowing into the muscle cells of the heart and blood vessels. These blockers cause the muscles to widen and relax, lowering a person's blood pressure and improving their circulation. The review of 13 studies (724 participants) found that giving calcium channel blockers during a kidney transplant operation reduces the chance of ATN after the operation. The effect of giving the blockers after the operation still needs to be investigated.

Abstract (click to read)

Background:

The incidence of delayed graft function in cadaveric grafts has increased over the last few years due in part to the large demand for cadaveric kidneys necessitating the use of kidneys from marginal donors. Calcium channel blockers have the potential to reduce the incidence of post-transplant acute tubular necrosis (ATN) if given in the peri-operative period. However, there is controversy surrounding their use in this situation with no consensus as to their efficacy.

Objectives:

To evaluate the benefits and harms of using calcium channel blockers in the peri-transplant period in patients at risk of ATN following cadaveric kidney transplantation.

Search strategy:

We searched the Cochrane Renal Group's specialised register, the Cochrane Central Register of Controlled Trials (CENTRAL, in The Cochrane Library) MEDLINE (from 1966) and EMBASE (from 1980). The Trials Search Coordinator was contacted to develop the search strategy.

Selection criteria:

Randomised controlled trials comparing calcium channel blockers given in the peri-transplant period with controls were included. Quasi-randomised trials were excluded.

Data collection and analysis:

Data was extracted and quality assessed independently by two reviewers, with differences resolved by discussion. Dichotomous outcomes are reported as risk ratio (RR) and measurements on continuous scales are reported as mean differences (MD) with 95% confidence intervals (CI).

Main results:

Thirteen trials (724 participants) were suitable for inclusion. Treatment with calcium channel blockers in the peri-transplant period was associated with a significant decrease in the incidence of post-transplant ATN (RR 0.62, 95% CI 0.46 to 0.85) and delayed graft function (RR 0.55, 95% CI 0.42 to 0.73). There was no difference between control and treatment groups in graft loss, mortality, requirement for haemodialysis. There was insufficient information to comment on adverse events.

Authors' conclusions:

These results suggest that calcium channel blockers given in the peri-operative period may reduce the incidence of ATN post-transplantation. The result should be treated with caution due to the heterogeneity of the trials which made comparison of studies and pooling of data difficult.

This record should be cited as:

Shilliday IR, Sherif M. Calcium channel blockers for preventing acute tubular necrosis in kidney transplant recipients. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD003421. DOI: 10.1002/14651858.CD003421.pub4

Assessed as up to date:

August 15, 2007

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Primary Review Group:

Renal Group

Health topics:

Kidney disease > Kidney transplant > Complications & co-interventions

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Calcium channel blockers can reduce the death of tubular cells in the kidney after a transplant operation

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