Use of renin-angiotensin-aldosterone system inhibitors within the first eight to twelve weeks after renal transplantation.
OBJECTIVE
To evaluate the safety and efficacy of early initiation of inhibitors of the renin-angiotensin-aldosterone system (RAAS) in renal transplant patients.


METHODS
A literature search was conducted using MEDLINE (1950-September 2007), PubMed (1966-September 2007), and International Pharmaceutical Abstracts (1970-September 2007) with combinations of the following terms: angiotensin-converting enzyme (ACE) inhibitors, angiotensin II type 1 receptor blockers (ARBs), and kidney transplant. Articles obtained from this search were cross-referenced and bibliographies were checked for all relevant information.


METHODS
All articles that examined the early (within 12 wk) initiation of either an ACE inhibitor or an ARB in renal transplant patients were included.


RESULTS
A search of the literature revealed 7 studies that had examined the safety or efficacy of early use of ACE inhibitors and ARBs in posttransplant patients. One study examined only plasma levels of a common marker for tissue fibrosis and one included only patients who had early graft dysfunction. Of the other 5 studies, 3 primarily reported safety endpoints and 2 reported clinical efficacy endpoints. Safety data in patients with functioning grafts (serum creatinine ranged from <2.5 to 3.0 mg/dL) show that early therapy with inhibitors of the RAAS did not result in appreciable increases in serum creatinine or potassium levels after up to 9 months of therapy. Results from the efficacy trials indicate that early initiation of an ACE inhibitor may be more effective than a beta-blocker in reducing left ventricular hypertrophy and proteinuria after 24 months of treatment.


CONCLUSIONS
It appears that the early initiation of RAAS inhibitors is safe in posttransplant patients with functioning grafts. It is reasonable to consider these agents as first-line pharmacotherapy in patients with hypertension and compelling indications (ie, diabetes or heart failure) in the first 12 weeks following transplant. Data are insufficient to recommend these drugs in patients with early graft dysfunction.
Jennings
Douglas L
DL
Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48201, USA. ag4098@wayne.edu
Taber
David J
DJ
D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D006084:Graft Rejection; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D017379:Hypertrophy, Left Ventricular / Q000188:drug therapy / Q000209:etiology; D016030:Kidney Transplantation; D011184:Postoperative Period; D011507:Proteinuria / Q000188:drug therapy / Q000209:etiology; D012084:Renin-Angiotensin System / Q000187:drug effects; D013997:Time Factors
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors