(527) - Does ACE Inhibitor Use in Heart Transplantation Decrease the Development of Cardiac Allograft Vasculopathy?

Abstract

The use of angiotensin converting enzyme (ACE) inhibitors in heart transplant has been reported to decrease development of cardiac allograft vasculopathy (CAV). ACE inhibition is also used for diabetics to protect their renal function. We chose to evaluate our heart transplant patients on ACE inhibition during the first year post-transplant to assess development of CAV and to assess its impact on first-year rejection and other complications. Between 2010 and 2012, we assessed 154 heart transplant patients for the use of ACE inhibitors. Patients were divided between those treated for hypertension with ACE inhibitors within the first 3-months post-transplant for a duration of at least 2 years compared to those not treated with ACE inhibitors. 3-year outcomes were assessed for survival, freedom from CAV and Non-Fatal Major Adverse Cardiac Events (NF-MACE: myocardial infarction, new congestive heart failure, percutaneous coronary intervention, implantable cardioverter defibrillator/pacemaker implant, stroke). 1-year outcomes included freedom from acute cellular rejection, antibody-mediated rejection and need for post-transplant dialysis. There was no significant difference between the group treated with ACE inhibitors and the group that was not treated with ACE inhibitors for 3-year survival and freedom from CAV and NF-MACE. There was also no difference between the two groups for 1-year freedom from cellular or antibody-mediated rejection, infection, or need for dialysis. (See table) ACE inhibitor use does not appear to provide protection against the development of CAV. Nonetheless, these drugs are important anti-hypertensive medications and there were no significant adverse effects from the use of these drugs.Tabled 1EndpointsNo ACE Inhibitor Use (N=110)ACE Inhibitor Use ≥ 2 Year(N=44)P-Value3-Year Survival95.1%97.6%0.4983-Year Freedom from CAV77.7%80.9%0.6743-Year Freedom from NF-MACE89.0%90.6%0.6961-Year Freedom from Acute Cellular Rejection91.3%93.1%0.7251-Year Freedom from Antibody Mediated Rejection95.2%95.4%0.9311-Year Freedom from Infection45.50%61.40%0.108Post-Transplant Dialysis10.0% (11/110)2.3% (1/44)0.181 Open table in a new tab