The association between angiotensin converting enzyme inhibitor or angiotensin receptor blocker use during postischemic acute transplant failure and renal allograft survival.
BACKGROUND
Postischemic acute renal transplant failure occurs in approximately one fourth of all dead donor transplantations. Uncertainty exists regarding the putative association between the use of angiotensin converting enzyme inhibitors (ACEIs) or angiotensin II AT1 receptor blockers (ARBs) and kidney transplant graft survival in patients with delayed allograft function.


METHODS
We conducted an open cohort study of all 436 patients who experienced an acute renal transplant failure out of all 2,031 subjects who received their first kidney transplant at the Medical University of Vienna between 1990 and 2003. Actual and functional graft survival was compared between users and nonusers of ACEI/ARB using exposure propensity score models and time-dependent Cox regression models.


RESULTS
Ten-year actual graft survival averaged 44% in the ACEI/ARB group, but only 32% in patients without ACEI/ARB (P=0.002). The hazard ratio of actual graft failure was 0.58 (95% confidence interval: 0.35-0.80, P=0.002) for ACEI/ARB users compared with nonconsumers. Seventy-one percent of subjects with ACEI/ARB had a functional graft at 10 years versus 64% of ACEI/ARB nonusers (P=0.027). The hazard ratio of functional graft loss was 0.48 (95% confidence interval: 0.24-0.91, P=0.025).


CONCLUSIONS
Use of ACEI/ARB in patients experiencing delayed allograft function was associated with longer actual and functional transplant survival.
Heinze
Georg
G
Core Unit of Medical Statistics and Informatics, Medical University of Vienna, Vienna, Austria.
Collins
Sean
S
Benedict
Michael A
MA
Nguyen
Louis L
LL
Kramar
Reinhard
R
Winkelmayer
Wolfgang C
WC
Haas
Martin
M
Kainz
Alexander
A
Oberbauer
Rainer
R
D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D051799:Delayed Graft Function / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D005260:Female; D006085:Graft Survival / Q000187:drug effects*; D006801:Humans; D007511:Ischemia / Q000150:complications; D007668:Kidney / Q000098:blood supply; D016030:Kidney Transplantation / Q000401:mortality; D008297:Male
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors