Hypertension is common among kidney transplant (KTx) recipients, but the impact of antihypertensive medication (AHM) choice on patient and graft outcomes is not well defined.

We examined a novel database linking SRTR registry data for 54,153 KTx recipients with AHM fill records from a large pharmaceutical claims warehouse (2008-2015). Mutually exclusive regimens were defined hierarchically as based in: Angiotensin converting enzyme inhibitor/angiotensin receptor blockers (ACEi/ARB), dihydropyridine calcium channel blockers (DHP-CCB), non-DHP (NDHP)-CCB, beta blockers or vasodilators/others. Associations (adjusted hazard ratio, _{95% LCL} aHR _{95% UCL}) of AHM regimen in mos 7-12 post-KTx with patient and graft survival over the next 5 yrs were quantified by multivariate Cox regression including adjustment for recipient, donor and transplant factors, and clustering for center.

The most common AHM after transplant were DHP-CCB, followed by beta-blockers, ACEi/ARB, and diuretics, but regimen patterns varied across transplant centers (Fig 1). In bi-level hierarchical modeling, compared to DHP-CCB-based treatment, ACEi/ARB use was more common in those with diabetes, obesity, and on mTORi-based immunosuppression. Unadjusted survival varied with AHM treatment (Fig 2). Compared to DHP-CCB regimen, adjusted mortality was higher in those managed with NDHP-CCB (aHR _1.111.24_1.37) and 'other' agents (aHR _1.441.69_2.00), but lower in patients treated with ACEi/ARB (aHR _0.850.920_.99).

While associations may in part reflect unobserved selection factors, these data motivate the need for controlled studies to determine optimal AHM regimens after KTx, reduce unjustified practice variation, and inform evidence-based best practices.

CITATION INFORMATION: Yamout H., Ouseph R., Schnitzler M., Xiao H., Dharnidharka V., Naik A., Lam N., Koraishy F., Randall H., Brennan D., Segev D., Kasiske B., Hess G., Lentine K. Antihypertensive Medication Use after Kidney Transplant: Practice Variation and Clinical Outcomes Am J Transplant. 2017;17 (suppl 3).

« Back to 2018 American Transplant Congress