title: Short- and long-term outcomes with renin-angiotensin-aldosterone inhibitors in renal transplant recipients: A meta-analysis of randomized controlled trials.
abstract: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor type 1 blockers (ARBs) are often prescribed for renal transplant recipients (RTRs), but the outcomes of these medications in RTRs remain controversial.
  
  
  
  The PubMed, Embase, and Cochrane Library databases were systematically searched. Randomized controlled trials investigating the outcomes of ACEI/ARBs in RTRs were included for meta-analysis.
  
  
  
  Twenty-two trials with 2242 patients were identified. After treatment for at least 12 months, ACEI/ARBs were associated with a decline in glomerular filtration rate (GFR) (weighed mean differences [WMD] -5.76 mL/min; 95% confidence intervals [CI]: -9.31 to -2.20) and a decrease in hemoglobin (WMD -9.81 g/L; 95% CI: -14.98 to -4.64). There were no significant differences in mortality between ACEI/ARB and non-ACEI/ARB groups (risk ratio [RR] 0.98, 95% CI: 0.58 to 1.76), nor in graft failure (RR 0.68, 95% CI: 0.38 to 1.32). After short-term treatment (less than 1 year), significant differences were found in changes of 24-hour proteinuria (WMD-0.57 g/d; 95% CI: -0.72 to -0.42) and serum potassium (WMD 0.25 mEq/L; 95% CI: 0.14 to 0.37) in ACEI/ARB groups compared to control arm, while these differences were not confirmed in the long run.
  
  
  
  This meta-analysis indicates ACEI/ARBs may be prescribed to RTRs with GFR and hemoglobin being carefully monitored.
authors.affiliation: Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Ruo-Xi
authors.initials: RX
authors.lastname: Liao
authors.affiliation: Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Xia-Fei
authors.initials: XF
authors.lastname: Lyu
authors.affiliation: Department of Hematology, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Wen-Jiao
authors.initials: WJ
authors.lastname: Tang
authors.affiliation: Department of Computer Science and Technology, Tsinghua University, Beijing, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Gao
mesh_terms: D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D018450:Disease Progression; D004359:Drug Therapy, Combination; D006801:Humans; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012084:Renin-Angiotensin System / Q000187:drug effects*; D066027:Transplant Recipients
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002121:Calcium Channel Blockers
keywords: angiotensin receptor blocker; angiotensin-converting enzyme inhibitor; meta-analysis; randomized controlled trials; renal transplant