Transplant Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA; Transplant Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC, USA.
Transplant Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA; Transplant Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC, USA; Medical Services, Ralph H. Johnson VA Medical Center, Charleston, SC, United States.
Am J Med Sci. 2024 Nov;368(5):432-437. doi: 10.1016/j.amjms.2024.07.009. Epub 2024 Jul 5.
Optimizing long-term graft survival remains a major focus in transplant. Elderly kidney transplant recipients are vulnerable to acute kidney injury (AKI) and graft loss. This study assessed the safety and efficacy of ACEI/ARB in elderly kidney transplant recipients and impact on graft outcomes.
Retrospective, longitudinal, cohort study of 500 patients age ≥60 years, who underwent kidney transplantation between 2005 and 2015. Demographic, transplant, and outcomes data were collected. Manual chart abstraction was conducted to determine medication use at discharge, one, three, and five years post-transplant. Univariate and multivariable Cox regression modeling were used to analyze outcomes.
Mean age of subjects was 66 years (range 60-81). 59% were males and 50% were African-American. 49% had chronic kidney disease (CKD) due to diabetes mellitus (DM). A total of 38, 134, 167, and 112 elderly kidney transplant recipients were on ACEI/ARB at discharge, one, three, and five years post-transplant respectively. ACEI/ARB initiated within one year of transplant was associated with lower risk of graft loss (HR=0.62, CI 0.38-0.99, p = 0.047). This was driven mainly by a lower risk of death (HR=0.41, CI 0.24-0.71, p = 0.002). ACEI/ARB use was associated with lower risk of AKI after 1 year (HR 0.70, CI 0.52-0.95, p = 0.02). ACEI/ARB was not associated with increased risk of acute rejection or hospitalization.
Initiation of ACEI/ARB within one year of transplant is associated with lower risk of AKI and graft loss, driven by lower risk of death in elderly kidney transplant recipients. Clinicians should maximize ACEI/ARB therapy early on after kidney transplant.
优化长期移植物存活率仍然是移植的主要关注点。老年肾移植受者易发生急性肾损伤（AKI）和移植物丢失。本研究评估了 ACEI/ARB 在老年肾移植受者中的安全性和疗效及其对移植物结局的影响。
这是一项回顾性、纵向队列研究，纳入了 2005 年至 2015 年间接受肾移植的 500 例年龄≥60 岁的患者。收集了人口统计学、移植和结局数据。通过手工图表摘录确定出院时、移植后 1、3 和 5 年的药物使用情况。采用单变量和多变量 Cox 回归模型分析结局。
研究对象的平均年龄为 66 岁（范围 60-81 岁）。59%为男性，50%为非裔美国人。49%因糖尿病（DM）导致慢性肾脏病（CKD）。共有 38、134、167 和 112 例老年肾移植受者在出院时、移植后 1 年、3 年和 5 年时分别开始使用 ACEI/ARB。移植后 1 年内开始使用 ACEI/ARB 与较低的移植物丢失风险相关（HR=0.62，CI 0.38-0.99，p=0.047）。这主要是由于死亡风险降低（HR=0.41，CI 0.24-0.71，p=0.002）所致。ACEI/ARB 与移植后 1 年 AKI 风险降低相关（HR 0.70，CI 0.52-0.95，p=0.02）。ACEI/ARB 与急性排斥反应或住院治疗风险增加无关。
移植后 1 年内开始使用 ACEI/ARB 与 AKI 和移植物丢失风险降低相关，这主要归因于老年肾移植受者死亡风险降低。临床医生应在肾移植后尽早最大化 ACEI/ARB 治疗。
