Original InvestigationsACE inhibitors and angiotensin II antagonists in renal transplantation: An analysis of safety and efficacy
Section snippets
Materials and methods
A retrospective cohort analysis was performed in the Renal Transplant Clinic at St Michael's Hospital, University of Toronto. The charts of all 642 active patients between 1981 and April 1998 were reviewed, and all patients who were prescribed an ACEi or ATII antagonist for any duration were eligible if they were followed-up in the clinic for a minimum of 6 months. There were three patients who did not return to the clinic for follow-up visits, and two patients who were followed-up in other
Results
One hundred seventy-seven of 642 RTRs (28%) were prescribed an ACEi or ATII antagonist. The time posttransplantation to medication prescription varied from immediately posttransplantation to 7,011 days, with a median of 286 days. The mean duration of therapy was 842 ± 887 days. The baseline patient demographics are depicted in Table 1.
. Baseline DemographicsEmpty Cell Empty Cell n % Age (y) Mean 49 177 Range 23-76 Transplant type Cadaveric 129 73 Living related 46 27 Native renal disease Glomerulonephritis 42 24 IgA nephropathy 28
Discussion
Through an emerging understanding of the mechanisms of chronic renal allograft dysfunction and of the systemic and intrarenal effects of ACEi and ATII antagonists, it is possible that these medications may prolong renal allograft survival. Although a randomized controlled trial is required to address this hypothesis, our findings suggest that ACEi and ATII antagonists can be safely used in RTRs.
Patients using either of these medications had decreases in MAP at all follow-up times as compared
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Received March 30, 1999; accepted in revised form July 16, 1999.
Address reprint requests to Jeffrey S. Zaltzman, MD, University of Toronto, Department of Medicine, Division of Nephrology, St Michael's Hospital, 30 Bond St, Toronto, Ontario, Canada M5B 1W8. E-mail: [email protected]