Background: Transplanting single baby kidneys into adults has an increased risk of early hyperfiltration injury during the first year. The renal protective effects of renin-angiotensin system (RAS) blockers are well documented in native kidneys, but remain inconclusive in transplanted kidneys. It is unknown if RAS blockers are beneficial in baby kidney transplants.
Methods: Retrospective analysis was done on adults who received single kidneys from donors <10, from 1996 to 2009 at our center. Depending on whether the patient was started on ACEi or ARB treatment for hyperfiltration injury as indicated by proteinuria in the first year of transplant, 94 patients were separated into group 1 with RAS blockers (n=40) and group 2 without RAS blockers (n=54).
Results: There were 27 patients treated with an ACEi, 10 with an ARB and 3 with both ACEi and ARB (group 1). There was no significant difference in any donor/recipient demographic between the two groups. Graft function, as well as the incidences of delayed graft function, acute rejection and late proteinuria after 1 year, was not statistically different in the two groups. Kaplan-Meier estimated death-censored graft survivals were significantly better in group 1 than in group 2 over 7 years: 95 vs. 81.2%, 82.4 vs. 61.2%, 72.6 vs. 58.5%, and 68.5 vs. 47.2% at 1, 3, 5, and 7 years, respectively (log rank p=0.043). Group 1 also had a trend for better patient survival than group 2: 100 vs. 92.6%, 94.9 vs. 83.3%, 92.1 vs. 79.4%, and 86.6 vs. 75.4% at 1, 3, 5, and 7 years, respectively (log rank p=0.107). Multivariable analysis found late proteinuria was a risk factor for graft loss (OR 2.70, 95%CI 1.33-5.49, p=0.006), while early RAS blockers reduced the risk of graft loss (OR 0.38, 95%CI 0.18-0.79, p=0.009). A sub-analysis of other patients initiated RAS blockers (n=19) after 1 year of transplant for various causes (FSGS, CAN and post-transplant erythrocytosis) did not show any graft or patient survival benefit.
Conclusion: Early RAS blockade therapy for hyperfiltration injury in the first year of transplant is associated with superior long-term graft survival among adults transplanted with single baby kidneys.
To cite this abstract in AMA style:LaGuardia H, Paramesh A, Killackey M, Mills K, McGee J, Buell J, Slakey D, Saggi B, Zhang R. Early Inhibition of the Renin-Angiotensin System Improves Long-Term Graft Survival of Single Baby Kidneys Transplanted in Adults [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/early-inhibition-of-the-renin-angiotensin-system-improves-long-term-graft-survival-of-single-baby-kidneys-transplanted-in-adults/. Accessed March 31, 2020.
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