As short-term outcomes have improved, optimizing long-term graft survival remains a major focus of transplant programs. Older kidney transplant recipients are particularly vulnerable to acute kidney injury (AKI) and graft loss. This study assessed the safety and efficacy of ACEI/ARB use in older kidney transplant recipients and impact on graft outcomes.

Methods: Retrospective, longitudinal, cohort study of 500 patients age ≥60, who underwent kidney transplantation between 2005-2015. Demographic data, transplant characteristics, and outcomes data were collected. Manual chart abstraction was conducted to determine cardiovascular medication use at discharge, 1 year, 3 years, and 5 years post-transplant. Univariate and multivariable Cox regression modelling were used to analyze outcomes based on medication utilization.

Results: Mean age of older kidney transplant recipients was 66 years (range 60-81). 59% were males and 50% were African-American. 49% had CKD due to DM. A total of 38, 134, 167, and 112 kidney transplant recipients were on ACEI/ARB at discharge, 1 year, 3 years, and 5 years post-transplant respectively. ACEI/ARB initiated within 1 year of transplant was strongly associated with lower risk of graft loss (HR=0.62, CI 0.38-0.99, p=0.047) (Fig. 1). This was driven mainly by a lower risk of death (HR=0.41, CI 0.24-0.71, p=0.002) (Fig. 2) in the older kidney transplant recipients. ACEI/ARB use was also associated with lower risk of AKI events after 1 year (HR 0.70, CI 0.52-0.95, p=0.02) (Fig. 3). Moreover, ACEI/ARB was not associated with increased risk of acute rejection or hospitalization. Statin or ASA use did not significantly impact graft outcomes.

Conclusion: Initiation of ACEI/ARB therapy within 1 year of transplant is strongly associated with lower risk of AKI events and graft loss, driven predominantly by lower risk of death in older kidney transplant recipients. Given the relatively low use of these agents, as compared to statins and ASA, transplant clinicians should work to maximize the initiation of ACEI/ARB therapy early on after kidney transplant.

CITATION INFORMATION: Posadas Salas M., Rodriguez R., Amaechi P., Rao V., Taber D. ACEI/ARB Use within One Year of Kidney Transplant is Associated with Less AKI and Graft Loss in Older Recipients Am J Transplant. 2017;17 (suppl 3).

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