Document Detail


Effects of ACE inhibitors on long-term outcome of renal transplant recipients: a randomized controlled trial.
MedLine Citation:
PMID:  23380881     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Available data on the role of renin-angiotensin system blockade in renal transplantation are inconclusive. Herein, we report the long-term results of a randomized controlled trial planned to evaluate the impact of angiotensin-converting enzyme inhibitors (ACE-i) on the cardiovascular outcome of renal transplant recipients (RTRs) receiving calcineurin inhibitors, steroids, and mycophenolate mofetil.
METHODS: Thirty-six RTRs were allocated to receive ACE-i and 34 served as controls. Survival free of a composite endpoint consisting of death, major cardiovascular events, renal graft loss or creatinine doubling, and survival free of each single endpoint were analyzed in both groups according to a modified intention-to-treat analysis.
RESULTS: During a 10-year follow-up, three patients died (one in the ACE-i group and two controls) and three lost their graft (two receiving ACE-i and one control). Three major cardiovascular events were observed in the ACE-i group and 12 among controls (P=0.008). At the end of observation, a significant increase in urinary protein excretion rate was only observed in controls (P=0.017).Compared with controls, RTRs administered ACE-i had significantly better survival free of the combined endpoint (P=0.0102, log-rank test) and free of major cardiovascular events (P=0.0027) without significant differences in renal outcome. By Cox regression analysis, ACE-i therapy resulted in the most powerful predictor of survival free of composite endpoint (hazard ratio, 0.165; 95% confidence interval, 0.053-0.512; P=0.0018) and survival free of major cardiovascular events (hazard ratio, 0.209; 95% confidence interval, 0.068-0.636; P=0.0059).
CONCLUSIONS: Prolonged therapy with ACE-i was associated with better general and cardiovascular outcome of RTRs without detrimental effects on renal graft function.
Authors:
Ernesto Paoletti; Diego Bellino; Luigina Marsano; Paolo Cassottana; Davide Rolla; Elena Ratto
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Transplantation     Volume:  95     ISSN:  1534-6080     ISO Abbreviation:  Transplantation     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-03-19     Completed Date:  2013-05-13     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  0132144     Medline TA:  Transplantation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  889-95     Citation Subset:  IM    
Affiliation:
Nephrology, Dialysis, and Transplantation Unit, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy. ernesto.paoletti@hsanmartino.it
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
Calcineurin / antagonists & inhibitors
Cardiovascular Diseases / prevention & control
Cohort Studies
Creatinine / blood
Disease-Free Survival
Female
Follow-Up Studies
Graft Survival
Humans
Kidney Transplantation / adverse effects*,  methods*
Male
Middle Aged
Mycophenolic Acid / analogs & derivatives,  pharmacology
Proportional Hazards Models
Treatment Outcome
Chemical
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 24280-93-1/Mycophenolic Acid; 60-27-5/Creatinine; 9242ECW6R0/mycophenolate mofetil; EC 3.1.3.16/Calcineurin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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