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Abstract: TH-PO167

Potential Beneficial Association of Renin-Angiotensin-Aldosterone-System Blockade and Graft Prognosis in Allograft IgA Nephropathy

Session Information

Category: Transplantation

  • 1802 Transplantation: Clinical

Authors

  • Park, Sehoon, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
  • Baek, Chung Hee, Asan Medical Center, Songpa-gu, seoul, Korea (the Republic of)
  • Cho, Hyunjeong, Chungbuk National University Hospital, Cheongju-si, Chungcheongbuk-do, Korea (the Republic of)
  • Yu, Mi-yeon, Seoul National University, Jong-no gu, Korea (the Republic of)
  • Kim, Yong Chul, SNUH, Seoul, Korea (the Republic of)
  • Lee, Jung Pyo, Seoul National University Boramae Medical Center, Seoul, Korea (the Republic of)
  • Kim, Yon Su, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
  • Park, Su-Kil, Asan Medical Center, Songpa-gu, seoul, Korea (the Republic of)
  • Ahn, Curie, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
  • Lee, Hajeong, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
Background

Clinical evidence supporting suggestions of using renin-angiotensin-aldosterone-system blockades (RAASB) for proteinuric recurrent glomerulonephritis after renal transplant was scarce. For allograft IgA nephropathy (IgAN), benefits of RAASB for graft prognosis remained controversial although the medication is consisting the mainstay for treatment of native IgAN.

Methods

We performed a bi-center retrospective cohort study on kidney transplant recipients diagnosed for IgAN in allograft biopsy. The included patients were stratified according to their prescribed maintenance hypertensive medication types within 6 months from their diagnosis. Patients those had follow-up duration less than 6 months were not considered in the analysis. The main outcome was 5-year death-censored-graft-failure (DCGF). Additional adjustment for other variables including presence of acute rejection or time-averaged eGFR after 3 months from diagnosis of allograft IgAN was performed, as clinicians may prescribe RAASB to those who were at stable allograft function.

Results

Among 558 patients with allograft IgAN, there were 38 patients who only received RAASB, and 33 patients who received single agent of CCB or BB. The other 121 patients were prescribed for other medications, mostly combination therapies. The RAASB group had relatively higher eGFR at the time of diagnosis for allograft IgAN but had higher degree of albuminuria and worse pathologic findings. The group of patients who received single antihypertensive agent other than RAASB (calcium channel blockers (CCB) or beta blockers (BB)) had significantly increased risk of DCGF (adjusted HR 2.68, 95% CI 1.08-6.67, P=0.03) than those who received single RAASB agent, and this was also similar in patients who received multiple antihypertensive medications (adjusted HR 2.20, 95% CI 1.02-4.74, P=0.04). In addition, this possible beneficial association of RAASB usage and graft prognosis was more prominent in patients who had albuminuria at the time of allograft IgAN diagnosis.

Conclusion

Usage of RAASB during the time of allograft IgAN diagnosis was associated with better prognosis compared with using other antihypertensive drugs. Our study is one of evidences encouraging the usage of RAASB in allograft IgAN patients.