***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Of 113 cyclosporine-treated primary renal allograft recipients , 60 were r and omized to receive st and ard therapy without diltiazem ( ND ) and 53 received st and ard therapy plus diltiazem ( D ) . There was no difference in CsA blood levels between ND and D at all intervals between 3 and 24 months follow-up , yet the D group required 35 % less CsA than the ND group ( measured at 12 months ) . At all intervals to 24 months there was no difference in blood pressure , renal function ( as measured by serum creatinine ) , or in the number of grafts lost between the 2 groups ( ND , 4 lost ; D , 3 lost ) . There was no significant difference in the total number of rejection episodes in the 2 groups ( ND , 89 episodes ; D , 71 episodes ) . However , the severity of rejection episodes was greater in the ND group as evidence d by a significant difference in the usage of OKT3 ( ND , 17 courses ; D , 8 courses of OKT3 , P<0.06 ) . Of the biopsy-proven episodes of rejection , there were more episodes of vascular rejection in the ND group ( ND , 14 episodes ; D , 3 episodes , P=0.005 ) . The incidence of primary nonfunction was less in the D group ( ND , 16 patients ; D , 5 patients , P=0.05 ) . It was concluded that the use of diltiazem was associated with a markedly reduced requirement for CsA without any adverse effect on graft function or graft outcome . Diltiazem with CsA was associated with fewer episodes of primary nonfunction and less-severe rejection episodes and in particular fewer episodes of vascular rejection BACKGROUND Hypertension and hyperuricaemia are common side-effects of cyclosporin A ( CsA ) treatment in renal transplant recipients . While it is well established that the calcium channel blocker amlodipine can control CsA-induced hypertension effectively in this patient population , recent evidence suggests amlodipine might also reduce hyperuricaemia . The present study was design ed to compare the effects of the calcium channel blocker amlodipine ( 5 - 10 mg/day ) and the beta-adrenoceptor antagonist tertatolol ( 5 - 10 mg/day ) on CsA-induced hyperuricaemia in post-renal transplant recipients with hypertension . METHODS Forty-eight hypertensive renal transplant recipients on a stable dose of CsA were r and omized in a double-blind , parallel-group manner to receive either amlodipine ( n = 24 ) or tertatolol ( n = 24 ) for 60 days . The primary outcome measure was the change from baseline in serum uric acid concentration . Secondary analyses of efficacy were based on changes in renal function and blood pressure . RESULTS Amlodipine significantly decreased serum uric acid levels from 483 + /- 99 to 431 + /- 110 microM/l ( P < 0.001 ) , while tertatolol significantly increased uric acid from 450 + /- 98 to 476 + /-84 microM/l ( P = 0.006 ) . Amlodipine also significantly increased glomerular filtration rate ( P = 0.0048 ) and the clearance rate of uric acid ( P = 0.023 ) and it reduced the fractional proximal tubular reabsorption of sodium ( P < 0.001 ) , compared with tertatolol . Renal plasma flow and filtered fraction were unaffected by both treatments , as was trough CsA blood concentration .  Amlodipine lowered systolic blood pressure to a significantly greater extent than did tertatolol ( P = 0.007 ) . The time-dependent profile of diastolic blood pressure did not differ significantly between treatment groups . Both drugs were well tolerated . CONCLUSIONS Amlodipine could be more appropriate than tertatolol for CsA-induced hypertension and hyperuricaemia in renal transplant recipients BACKGROUND After successful kidney transplantation patients may suffer from the adverse effects due to the use of calcineurin inhibitors . Calcium channel blockers are effective in the treatment of hypertension and may ameliorate cyclosporine- ( CsA ) induced impairment of renal function after kidney transplantation . Calcium channel blockers may also modulate the immune-system which may result in reduction of acute rejection episodes . PATIENTS AND METHODS From June 1995 till 1997 the effect of isradipine ( Lomir ) on renal function , incidence and severity of delayed graft function ( DGF ) , and acute rejection after kidney transplantation , was studied in 210 renal transplant recipients , who were r and omized to receive isradipine ( n=98 ) or placebo ( n=112 ) after renal transplantation in a double-blind fashion . RESULTS In the isradipine group renal function was significantly better at 3 and 12 months ( P=0.002 and P=0.021 ) compared with the placebo group . DGF was present in both groups : isradipine : (28 + 6)/98 ( 35 % ) ; placebo : (35 + 9)/112 ( 40 % ) , P=0.57 . Severity of DGF was comparable in both groups ( isradipine : 9.1+/-8.7 vs. placebo : 9.3+/-8.1 days ) . No statistical difference was found in incidence or severity of biopsy-proven acute rejection [ isradipine : (42 + 6)/98 ( 49 % ) versus placebo : (46 + 9)/112 ( 49 % ) , P=1.00 ] . Renal vein thrombosis was observed in eight patients . This proved to be associated with the route of administration of the study medication [ 6/45 ( 13 % ) on i.v . medication versus 2/165 ( 1 % ) on oral medication , P<0.001 ] . CONCLUSIONS Addition of isradipine results in a better renal function after kidney transplantation , without effect on incidence or severity of DGF or acute rejection Intrarenal vasoconstriction is a characteristic feature of CsA nephrotoxicity . The influence of nifedipine , a dihydropyridine calcium channel blocker and potent renal vasodilator , on renal haemodynamics was investigated in 11 cyclosporin A (CsA)- and 9 azathioprine (Aza)-treated normotensive long-term renal allograft recipients . Baseline Cr51-EDTA clearance and effective renal plasma flow ( ERPF ) were similar in both groups . Nifedipine 20 mg twice daily for 28 days significantly increased Cr51-EDTA clearance ( + 14.8 % ) in the CsA group ; however , ERPF , renal vascular resistance ( RVR ) , and filtration fraction did not change . Nifedipine did not influence renal haemodynamics in the azathioprine group . The increase in Cr51-EDTA clearance in the CsA group did not correlate with baseline renal function , CsA dose or whole blood levels , donor age , duration of graft , or renal functional reserve capacity . This study suggests that nifedipine confers a beneficial effect on renal haemodynamics in long-term CsA-treated renal allograft recipients and appears to improve renal function by a non-haemodynamic mechanism Verapamil has proven effective in preventing acute renal failure in animal models if given prior to the insult and hence possibly has a role in the preservation of cadaveric renal tissue for transplantation . Twenty renal donors were r and omly assigned to treatment ( receiving verapamil 20 mg intravenously ) and control groups . Recipients were monitored for renal failure by urine output and serum creatinines on days 1 and 7 and dialysis requirement to one week . Early urine outputs and serum creatinines ( day 1 ) were significantly better in the treated than control group ( p greater than 0.01 , 0.05 respectively ) . We conclude therefore that verapamil may prevent post-transplant acute renal failure , but its optimal dosage and route of administration remain to be determined The purpose was to study whether the calcium entry blocker , felodipine , could reduce the nephrotoxic and hypertensive effect of cyclosporine .  The effect of felodipine on glomerular filtration rate ( GFR ) , renal plasma flow ( RPF ) , fractional excretion of sodium , lithium clearance and blood pressure was measured in three r and omized , placebo-controlled studies of cyclosporine treated patients . In study one , 10 renal transplant recipients were examined within the first six months after transplantation in a cross-over design . Renal hemodynamics were determined after the acute ingestion of felodipine or placebo , with an interval of less than one week between the two examinations . In study two , 79 renal transplant recipients were r and omized to a treatment with  felodipine or placebo just before transplantation , and renal hemodynamics were determined after twelve weeks . In study three , 18 patients , who were treated with cyclosporine due to dermatological diseases , were examined in a cross-over design to determine their renal hemodynamics after four weeks of treatment with felodipine or placebo . Felodipine increased renal hemodynamics in study one ( GFR 16 % , RPF 33 % , P < 0.01 for both ) , in study two ( GFR 23 % , RPF 28 % , P < 0.05 for both ) , and in study three ( GFR 13 % , RPF 26 % , P < 0.01 for both ) . FE(Na ) was significantly increased by felodipine in studies one and three , but not in study two . Lithium clearance was significantly increased and blood pressure significantly reduced by felodipine in all three studies . It can be concluded that felodipine counteracts both the cyclosporine induced impairment in renal hemodynamics and the increase in blood pressure in acute and short-term studies Background . Studies have provided conflicting results as to the protective role of calcium channel blockers ( CCB ) in  cyclosporine-treated patients with regard to blood pressure control and preservation of renal graft function .  Lacidipine is a dihydropyridine CCB that possesses antioxidative , anti-atherosclerotic , and anti-adhesion properties and was shown to prevent cyclosporine-induced nephrotoxicity in a rat model . Methods . We conducted a multicenter prospect i ve , r and omized , placebo-controlled study in 131 de novo recipients of a cadaveric renal allograft on cyclosporine therapy .  The aim of this 2-year study was to assess the effects of lacidipine on graft function ( plasma iohexol clearance ) , renal plasma flow , anastomotic arterial blood flow , deterioration of renal function , blood pressure , acute rejection , and hospitalization rate . Results . A total of 118 recipients were available for intention-to-treat analysis on efficacy ( lacidipine : n=59 ; placebo : n=59 ) . Graft function assessed by serum creatinine concentration and glomerular filtration rate measured as plasma iohexol clearance , was persistently better in lacidipine-treated patients from 1 year onwards ( respectively , P<0.01 and P<0.05 ) . Renal plasma flow and anastomotic blood flow were not significantly higher in lacidipine-treated patients . Three patients on lacidipine therapy and four on placebo experienced treatment failure defined as an increase in serum creatinine from baseline of more than 60 % ( log-rank test : P=0.57 ) . Study groups did not differ in acute rejection rate , trough blood cyclosporine concentrations , blood pressure , number of antihypertensive drugs , hospitalization rate , and adverse event rate . Conclusions . The use of calcium channel blockers in cyclosporine-treated renal recipients results in a significantly better allograft function at 2 years and this effect is independent of blood pressure lowering A local measurement of the partial pressure of oxygen in the renal cortex was performed during renal transplantation in 40 patients aged between 10 and 62 years . During the measurement , 20 of the patients received the calcium channel blocker diltiazem . Accurate knowledge of the renal microcirculation in the postischemic phase became possible when PO2 tissue polarography was performed . Moreover , measurement in four live donors before removal of the kidneys allowed an exact comparison between the postischemic microcirulation and the native in situ perfusion . A good postischemic baseline histogram ( similar to the situation in a live donor ) or quick stabilization of the histogram during the course was found to correlate with a prompt initial renal function . Intra-arterial administration of diltiazem led to an insignificant improvement of the primary function rate . In the case of kidneys with longer cold ischemic periods and initially indifferent baseline histograms there was an especially pronounced benefit of diltiazem administration . Not only macroscopic examination , but also polarographic measurements revealed an improvement in the renal microcirculation throughout , with higher mean values for PO2 and homogeneity of all PO2 values measured after administration of diltiazem . In keeping with this , in such cases the incidence of primary renal function was distinctly higher . In cases with improved cortical circulation the a-v oxygen difference was less pronounced , so that evaluation of the avDO2 determinations suggests distinct perfusion improvement following diltiazem Calcium antagonists ( CATs ) have a role in the management of certain types of renal insufficiency . These include prophylaxis against post-transplant-associated acute renal failure and cyclos 
    Output:
    
These results suggest that calcium channel blockers given in the peri-operative period may reduce the incidence of ATN post-transplantation .