title: Early inhibition of the renin-angiotensin system improves the long-term graft survival of single pediatric donor kidneys transplanted in adult recipients.
abstract: Transplanting single pediatric donor kidneys into adult recipients has an increased risk of hyperfiltration injury and graft loss. It is unknown if renin-angiotensin system (RAS) blockers are beneficial in this setting. We retrospectively analyzed 94 adults who received single kidneys from donors <10 years old during 1996-2009. The recipients were divided into group 1 with RAS blockers (n = 40) and group 2 without RAS blockers (n = 54) in the first year of transplant. There was no significant difference in any donor/recipient demographic between the two groups. Graft function, incidence of delayed graft function, acute rejection, and persistent proteinuria were not statistically different either. Kaplan-Meier estimated death-censored graft survivals were significantly better in group 1 than in group 2: 95 vs. 81.2%, 82.4 vs. 61.2%, 72.6 vs. 58.5%, and 68.5 vs. 47.2% at 1, 3, 5, and 7 years, respectively (log rank P = 0.043). Multivariable analysis found persistent proteinuria was a risk factor for graft loss (OR 2.70, 95% CI 1.33-5.49, P = 0.006), while RAS blockers reduced the risk of graft loss (OR 0.38, 95% CI 0.18-0.79, P = 0.009). Early RAS blockade therapy in the first year of transplant is associated with superior long-term graft survival among adults transplanted with single pediatric donor kidneys.
authors.affiliation: Department of Medicine, School of Medicine, School of Public Health and Tropic Medicine, Tulane University, New Orleans, LA 70112, USA. rzhang@tulane.edu
authors.forename: Rubin
authors.initials: R
authors.lastname: Zhang
authors.forename: Heather
authors.initials: H
authors.lastname: Laguardia
authors.forename: Anil
authors.initials: A
authors.lastname: Paramesh
authors.forename: Katherine
authors.initials: K
authors.lastname: Mills
authors.forename: Mary
authors.initials: M
authors.lastname: Killackey
authors.forename: Jennifer
authors.initials: J
authors.lastname: McGee
authors.forename: Brent
authors.initials: B
authors.lastname: Alper
authors.forename: Eric
authors.initials: E
authors.lastname: Simon
authors.forename: Lotuce
authors.initials: L
authors.lastname: Lee Hamm
authors.forename: Douglas
authors.initials: D
authors.lastname: Slakey
mesh_terms: D000328:Adult; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000502:physiology; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000517:prevention & control; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012189:Retrospective Studies; D014019:Tissue Donors
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors