title: The Effect of Renin-angiotensin System Inhibitors on Kidney Allograft Survival: A Systematic Review and Meta-analysis.
abstract: BACKGROUND
  The use of renin-angiotensin system (RAS) inhibitors in patients with chronic kidney disease, and especially in diabetic kidney disease, has been shown to provide renoprotective effects and slow progression to end-stage renal disease. However, this protective effect in kidney transplant patient populations is unclear.
  
  
  OBJECTIVE
  The objective of this systematic review and meta-analysis was to evaluate the effect of RAS inhibitors on kidney allograft survival.
  
  
  METHODS
  A literature search for randomized controlled trials (RCTs) was performed from inception through February 2016. Studies that reported relative risks or hazard ratios comparing the risks of renal graft loss in renal transplant recipients who received RAS inhibitors vs. controls were included. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a random-effect, generic inverse variance method.
  
  
  RESULTS
  Five studies (3 RCTs and 2 cohort studies) with 20024 kidney transplant patients were included in the meta-analysis. Pooled RR of allograft failure in recipients who received RAS inhibitors was 0.73 (95% CI: 0.45-1.21). When meta-analysis was limited only to RCTs, the pooled RR of allograft failure in patients using RAS inhibitors was 0.59 (95%: CI 0.20-1.69). The risk for mortality (RR: 1.13 [95% CI: 0.62-2.07]) in patients using RAS inhibitors compared to controls was not significantly reduced.
  
  
  CONCLUSIONS
  This meta-analysis demonstrated insignificant reduced risks of renal graft loss among renal transplant recipients who received RAS inhibitors. Future studies assessing the potential benefits of RAS inhibitors on allograft survival in specific kidney transplant patient populations are needed.
authors: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.
authors: Wisit
authors: W
authors: Cheungpasitporn
authors: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.
authors: Charat
authors: C
authors: Thongprayoon
authors: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.
authors: Michael A
authors: MA
authors: Mao
authors: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.
authors: Wonngarm
authors: W
authors: Kittanamongkolchai
authors: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.
authors: Insara J J
authors: IJ
authors: Sathick
authors: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.
authors: Stephen B
authors: SB
authors: Erickson
keywords: Angiotensin-converting enzyme inhibitors; angiotensin II receptor blockers; kidney transplantation; renin-angiotensin system inhibitors; transplantation