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. 2024 Dec 11:15:1522558.
doi: 10.3389/fphar.2024.1522558. eCollection 2024.

Safety of ACEI/ARB use in the early (<3 months) post kidney transplant period: a systematic review and meta-analysis

Dahai Fu #  1 , Jin Li #  1 , Guanglan Zeng  1 , Maozhi Tang  2
Affiliations

Safety of ACEI/ARB use in the early (<3 months) post kidney transplant period: a systematic review and meta-analysis

Dahai Fu et al. Front Pharmacol. .

Abstract

Background: Data about the safety of ACEI/ARB use in early (<3 months) posttransplant period are restricted and remain controversial.

Methods: This systematic review and meta-analysis included searches of PubMed, Embase and CENTRAL from inception to 31 November 2023, for studies to compare the safety (transplant outcomes and postoperative complications) of ACEI/ARB with non-ACEI/ARB (other antihypertensive medications) initiation in early post kidney transplant period.

Results: Of 1,247 citations identified, 13 eligible studies involving 1919 patients were enrolled for analyses. In short- or long-term observations, there were no differences on pooled serum creatinine between ACEI/ARB and non-ACEI/ARB groups whether initiated within 1 or 1-3 months posttransplant, however, initiation of ACEI/ARB within the first month posttransplant had an advantage effect on the mean creatinine clearance. Early initiation of ACEI/ARB posttransplant reduced the risks of patient death (RR 0.60, p = 0.009) and graft loss (RR 0.54, p = 0.0002). For postoperative complications, there were no significant differences in acute rejection risk (RR 0.87, p = 0.58), delayed graft function risk (RR 1.00, p = 0.93), hemoglobin level (MD -0.32 mg/Dl, p = 0.46) or urinary protein excretion (MD -0.10 g/24 h, p = 0.16) between two groups. However, the ACEI/ARB group had higher incidence of hyperkalemia (RR 2.43, p = 0.02).

Conclusion: Early initiation of ACEI/ARB within 3 months posttransplant proved to be basically safe and has renal function recovery benefits, however, hyperkalemia needs to be noted.

Keywords: angiotensin converting enzyme inhibitor; angiotensin receptor blocker; kidney transplant; meta-analysis; safety.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flow chart for literature search and study selection.
FIGURE 2
FIGURE 2
Forest plots of mean creatinine clearance differences between the ACEI/ARB and non-ACEI/ARB groups in short term observation. ACEI/ARB initiated within the first month posttransplant (2.1.1) and at 1–3 months posttransplant (2.1.2). CI, confidence interval.
FIGURE 3
FIGURE 3
Forest plots of mean serum creatinine differences between the ACEI/ARB and non-ACEI/ARB groups in short term observation. ACEI/ARB initiated within the first month posttransplant (4.1.1) and at 1–3 months posttransplant (4.1.2). CI, confidence interval.
FIGURE 4
FIGURE 4
Forest plots of mean creatinine clearance differences between the ACEI/ARB and non-ACEI/ARB groups in long term observation. ACEI/ARB initiated within the first month posttransplant (3.1.1) and at 1–3 months posttransplant (3.1.2). CI, confidence interval.
FIGURE 5
FIGURE 5
Forest plots of mean serum creatinine differences between the ACEI/ARB and non-ACEI/ARB groups in long term observation. ACEI/ARB initiated within the first month posttransplant (5.1.1) and at 1–3 months posttransplant (5.1.2). CI, confidence interval.
FIGURE 6
FIGURE 6
Forest plots depicting the risk ratios of acute rejection (AR) of early initiation of ACEI/ARB versus non-ACEI/ARB groups. ACEI/ARB initiated within the first month posttransplant (6.1.1) and at 1–3 months posttransplant (6.1.2). CI, confidence interval.
FIGURE 7
FIGURE 7
Forest plots depicting the risk ratios of delayed graft function (DGF) of early initiation of ACEI/ARB versus non-ACEI/ARB groups. CI, confidence interval.
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