Background: Mortality in allograft kidney transplant recipients is high, and cardiovascular disease is the leading cause of death in these patients. They have heightened activity of sympathetic and renin-angiotensin systems. We tested the hypothesis that blockade of sympathetic and renin-angiotensin systems in these patients may offer a survival benefit using a large cohort of patients with long-term follow up.
Methods and results: Medical records of 321 consecutive patients from our institution who had received renal transplantation between 1995 and 2003 were abstracted. Survival was analyzed as a function of pharmacological therapies adjusted for age, sex, and comorbidities. The characteristics of the 321 patients were as follows: age at transplant, 44±13 years; 40% male; 89% with hypertension; 36% with diabetes, and mean left ventricular ejection fraction of 60%. Over a follow-up of 10±4 years, there were 119 deaths. Adjusted for age, sex, diabetes, and coronary artery disease, use of a beta-blocker therapy (P=0.04) and angiotensin-converting enzyme inhibitor or receptor blocker (P=0.03) was associated with better survival. This treatment effect was seen across all major clinical subgroups and was supported by propensity score analysis. The propensity score-adjusted 10-year survival was 95% in those taking both groups of medications, 72% in those taking either of them, and 64% in those taking neither (P=0.004).
Conclusions: Use of beta-blocker and angiotensin blocking therapies is associated with higher survival after renal transplantation, indicating their potential protective role in this high-risk population.