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Abstract: PO2118

Discontinuation of Renin-Angiotensin System Blockade Among Kidney Transplant Recipients

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Mcallister, Sophie, University of California San Francisco School of Medicine, San Francisco, California, United States
  • Siyahian, Salpi, University of California San Francisco, San Francisco, California, United States
  • Seth, Divya, University of California San Francisco, San Francisco, California, United States
  • Ku, Elaine, University of California San Francisco, San Francisco, California, United States
Background

Cardiovascular disease is common among recipients of kidney transplantation and is associated with high morbidity and mortality. While recent studies have shown evidence of cardiovascular benefit with the continuation of renin-angiotensin system (RAS) blockade for transplant-naïve patients with CKD there are little data on whether cessation of RAS blockade among kidney transplant recipients has kidney, cardiovascular, or survival benefits (or risks).

Methods

We performed a retrospective cohort study of kidney transplant recipients from the FAVORIT study. We included participants enrolled in the US who received an ARB or ACEi by self-report at one or more FAVORIT visits and performed a propensity score (PS) weighted Cox survival analysis to examine the risks or benefits of RAS discontinuation (vs. continuation). Outcomes were risk of death, return to dialysis, and major adverse cardiovascular events (MACE; stroke, myocardial infarction, coronary revascularization, or heart failure). Doubly robust estimation was also used on the PS weighted sample to provide conservative estimates.

Results

2,009 US participants had at least one visit where they reported taking a RAS inhibitor. 30% (n=598) of participants discontinued RAS blockade. Compared to those who continued RAS blockade, participants who discontinued RAS blockade were significantly less likely to experience mortality, return to dialysis, and MACEs (Table).

Conclusion

Kidney transplantation recipients who stopped RAS blockade had lower rates of mortality, return to dialysis, and MACEs compared to those who continued RAS blockade. These data may be useful when deciding on the risks and benefits of continuing RAS blockade for patients receiving kidney transplantation.

Hazard of adverse outcomes for kidney transplantation recipients discontinuing vs. continuing ACEi/ARB
 Mortality
HR (95% CI)
Dialysis
HR (95% CI)
MACE
HR (95% CI)
Unweighted adjusted model0.72 (0.54-0.96)0.71 (0.51-0.99)0.63 (0.47-0.85)
Propensity-score weighted unadjusted model0.75 (0.57-1.00*)0.77 (0.56-1.07)0.64 (0.48-0.85)
Propensity-score weighted adjusted model (doubly robust)0.72 (0.55-0.96)0.71 (0.51-0.99)0.62 (0.46-0.83)

*p<0.05 Adjusted for age at discontinuation, sex, race, ethnicity, use of calcineurin inhibitor or mTOR inhibitor use, diabetes, systolic blood pressure, and eGFR