Use of angiotensin-converting enzyme inhibitors and angiotensin II antagonists in renal transplantation: Delaying the progression of chronic allograft nephropathy?

Abstract

Advances in immunosuppressive therapy have improved the survival of both cadaveric and living donor renal transplants. The improved long-term survival is probably a consequence of these advances and concurrent improvements in the general medical management of the transplant recipients. One area of care that remains controversial in renal transplantation is the use of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blocker (ARB). ACEI and ARB are now commonly used in patients with chronic renal insufficiency, proteinuria and hypertension caused by the disease of their own native kidneys. This article reviews the potential benefits of interrupting the production of angiotensin II (All) or blockade of the AT1 receptor for All in renal transplant recipients. The current hypotheses for the pathophysiology and the cytokine abnormalities in the progression of renal dysfunction include a facilitative role for All. In addition, calcineurin inhibitor nephrotoxicity, with the increased generation of transforming growth factor-β, is also affected by the actions of All. It is suggested that ACEI and ARB be used more widely in transplantation patients.