ACEI/ARB use within one year of kidney transplant is associated with less AKI and graft loss in elderly recipients.

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.