RAS Blockade Improves Transplant Patient Survival

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Medications that block the renin-angiotensin system (RAS) may improve survival among renal transplant recipients, according to researchers.

In a study of 990 recipients of a deceased donor kidney, Domingo Hernández, MD, of the Hospital Regional Universitario Carlos Haya in Málaga, Spain, and colleagues found that those who received an ACE inhibitor (ACEI) or angiotensin receptor blocker (ARB) had a significant 37% decreased risk of death compared with recipients who did not, after adjusting for confounding variables. Use of these drugs, however, was not associated with a significant improvement in graft survival.

Writing in Nephrology Dialysis Transplantation (published online ahead of print), the researchers observed that it is plausible that the real beneficial effect of RAS blockade on graft survival may be overwhelmed by multiple transplant-related immunological and nonimmunological factors that are not targeted by ACEIs or ARBs. Moreover, Dr. Hernández's team noted, nephrologists are more likely to prescribe ACEI/ARB therapy when some transplant clinical parameters are favorable following renal transplantation, “which may also mask the true effects of this therapy.”

Of the 990 recipients, 414 received an ACEI or ARB during the study period (median duration of 14 months). The median follow-up was 52 months.

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