Background: Angiotensin converting enzyme inhibitors (ACEI) and angiotensin recpetor blockers(ARB)) are well documented to be potent antihypertensives with renoprotective effects but are grossly underutilized in renal transplant recipients. This is mainly for fear of rise in serum creatinine and potassium levels. They are also known to decrease hemoglobin levels.

Methods: We reviewed 1691 kidney or kidney/pancreas transplant recipients between January 2006 and December 2011 at our institution. 672 patients were initiated on either ACEI or ARB (or both) therapy by their second year post-transplant. Only patients initiating therapy after day 365 and before day 1080 were included. The other 1019 patients receiving no ACEI or ARB therapy served as the control group. Patient and graft survival and baseline lab values prior to therapy and 12 months after initiation of ACEI/ARB were collected. Similar data was collected on patients not receiving ACEI/ARB therapy at one and 3 years post-transplant.

Results: While baseline creatinine was higher in the ACEI/ARB treatment group, follow up creatinine was significantly reduced by (delta) 0.07 mg/dL at one year. Hemoglobin did appear to be affected by ACEI/ARB therapy, resulting in an average reduction of 0.16 mg/dl by 12th month from 12.6 to 12.44 gm/dL. However, erythropoietin agent (ESA) use was similar in both groups. Average potassium levels did not differ significantly between groups and were in normal clinical ranges. While incidence of graft failure did not differ, death with functioning graft was lower in the ACEI/ARB group.

Conclusions:1) ACEI/ ARBs can be used successfully post-renal transplant with beneficial long term impact on renal function. 2) While the impact on anemia may be statistically different, there was no difference in need for ESAs. 3) Reduced morbidity and mortality in treated patients may be a function of cardiovascular benefits of ACEI/ARB therapy.

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