Effects of ACE inhibitors on long-term outcome of renal transplant recipients: a randomized controlled trial.
Paoletti E, Bellino D, et al.Transplantation. 2013; 95(6):889-95.
Aims
To evaluate the impact of angiotensin-converting enzyme inhibitors (ACE-i) on cardiovascular outcomes of renal transplant recipients receiving calcineurin inhibitors, steroids and mycophenolate mofetil.
Interventions
The intervention group received an initial dose of lisinopril at 5mg per day. The control group did not receive treatment.
Participants
70 non diabetic kidney transplant (deceased donor) recipients with left ventricular hypertrophy and stable renal graft function within three months of their transplantation.
Outcomes
The outcomes included death, time to the first nonfatal cardiovascular event (MI, coronary revascularisation, hospitalisation for acute coronary syndrome, heart failure, arrhythmias, peripheral vascular event, or cerebrovascular event) and time to the first renal event (start of dialysis due to graft loss or serum creatinine doubling).
Follow-up
10 years.
CET Conclusions
This study reports a 10 year follow up of a randomised controlled trial in recipients with left ventricular hypertrophy comparing ACE inhibitors with no ACE inhibitors, although conventional anti hypertensive drugs were permitted in both arms. There was a better general and cardiovascular outcome in the patients receiving ACE inhibitors and there was no detrimental effect on renal graft function in the ACE inhibitor group.
Data analysis
Modified intention-to-treat analysis
Trial registration
ISRCTN94487168