Beta and angiotensin blockades are associated with improved 10-year survival in renal transplant recipients

Abstract

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.

Figure 1.

Survival curves of patients with and without β‐blocker (BB) therapy adjusted for propensity score.

Figure 2.

Survival curves, adjusted for propensity score, of patients with and without angiotensin‐blocking (AB) therapy with an angiotensin receptor blocker or an angiotensin‐converting enzyme inhibitor.

Figure 3.

Survival curves, adjusted for propensity score, of patients who took β‐blocker (BB) and angiotensin‐blocking (AB) therapy vs those who took neither or either. ARB indicates angiotensin receptor blocker.