Abstract：
BACKGROUND: The use of renin-angiotensin system (RAS) inhibitors in patients with chronic kidney disease, and especially in diabetic kidney disease, has been shown to provide renoprotective effects and slow progression to end-stage renal disease. However, this protective effect in kidney transplant patient populations is unclear.
OBJECTIVE: The objective of this systematic review and meta-analysis was to evaluate the effect of RAS inhibitors on kidney allograft survival.
METHODS: A literature search for randomized controlled trials (RCTs) was performed from inception through February 2016. Studies that reported relative risks or hazard ratios comparing the risks of renal graft loss in renal transplant recipients who received RAS inhibitors vs. controls were included. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a random-effect, generic inverse variance method.
RESULTS: Five studies (3 RCTs and 2 cohort studies) with 20024 kidney transplant patients were included in the meta-analysis. Pooled RR of allograft failure in recipients who received RAS inhibitors was 0.73 (95% CI: 0.45-1.21). When meta-analysis was limited only to RCTs, the pooled RR of allograft failure in patients using RAS inhibitors was 0.59 (95%: CI 0.20-1.69). The risk for mortality (RR: 1.13 [95% CI: 0.62-2.07]) in patients using RAS inhibitors compared to controls was not significantly reduced.
CONCLUSIONS: This meta-analysis demonstrated insignificant reduced risks of renal graft loss among renal transplant recipients who received RAS inhibitors. Future studies assessing the potential benefits of RAS inhibitors on allograft survival in specific kidney transplant patient populations are needed.
OBJECTIVE: The objective of this systematic review and meta-analysis was to evaluate the effect of RAS inhibitors on kidney allograft survival.
METHODS: A literature search for randomized controlled trials (RCTs) was performed from inception through February 2016. Studies that reported relative risks or hazard ratios comparing the risks of renal graft loss in renal transplant recipients who received RAS inhibitors vs. controls were included. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a random-effect, generic inverse variance method.
RESULTS: Five studies (3 RCTs and 2 cohort studies) with 20024 kidney transplant patients were included in the meta-analysis. Pooled RR of allograft failure in recipients who received RAS inhibitors was 0.73 (95% CI: 0.45-1.21). When meta-analysis was limited only to RCTs, the pooled RR of allograft failure in patients using RAS inhibitors was 0.59 (95%: CI 0.20-1.69). The risk for mortality (RR: 1.13 [95% CI: 0.62-2.07]) in patients using RAS inhibitors compared to controls was not significantly reduced.
CONCLUSIONS: This meta-analysis demonstrated insignificant reduced risks of renal graft loss among renal transplant recipients who received RAS inhibitors. Future studies assessing the potential benefits of RAS inhibitors on allograft survival in specific kidney transplant patient populations are needed.
摘要：
背景：在慢性肾脏病患者中使用肾素-血管紧张素系统（RAS）抑制剂，尤其是糖尿病肾病，已被证明具有肾脏保护作用并减缓终末期肾病的进展。然而,这种对肾移植患者人群的保护作用尚不清楚.
目的：本系统综述和荟萃分析的目的是评估RAS抑制剂对同种异体肾移植存活的影响。
方法：从开始到2016年2月对随机对照试验（RCT）进行了文献检索。报告了相对风险或风险比的研究，比较了接受RAS抑制剂的肾移植受者中肾移植物丢失的风险与控制包括在内。集合风险比(RR)和95%置信区间(CI)使用随机效应计算，泛型方差逆方法。
结果：5项研究（3项随机对照试验和2项队列研究）纳入了20024例肾移植患者的荟萃分析。接受RAS抑制剂的受体同种异体移植失败的合并RR为0.73（95％CI：0.45-1.21）。当荟萃分析仅限于随机对照试验时，在使用RAS抑制剂的患者中,同种异体移植失败的合并RR为0.59(95%:CI0.20-1.69).与对照组相比，使用RAS抑制剂的患者的死亡风险（RR：1.13[95％CI：0.62-2.07]）没有显着降低。
结论：这项荟萃分析表明，接受RAS抑制剂的肾移植受者中，肾移植物丢失的风险降低不明显。未来的研究需要评估RAS抑制剂对特定肾移植患者群体中同种异体移植物存活的潜在益处。
目的：本系统综述和荟萃分析的目的是评估RAS抑制剂对同种异体肾移植存活的影响。
方法：从开始到2016年2月对随机对照试验（RCT）进行了文献检索。报告了相对风险或风险比的研究，比较了接受RAS抑制剂的肾移植受者中肾移植物丢失的风险与控制包括在内。集合风险比(RR)和95%置信区间(CI)使用随机效应计算，泛型方差逆方法。
结果：5项研究（3项随机对照试验和2项队列研究）纳入了20024例肾移植患者的荟萃分析。接受RAS抑制剂的受体同种异体移植失败的合并RR为0.73（95％CI：0.45-1.21）。当荟萃分析仅限于随机对照试验时，在使用RAS抑制剂的患者中,同种异体移植失败的合并RR为0.59(95%:CI0.20-1.69).与对照组相比，使用RAS抑制剂的患者的死亡风险（RR：1.13[95％CI：0.62-2.07]）没有显着降低。
结论：这项荟萃分析表明，接受RAS抑制剂的肾移植受者中，肾移植物丢失的风险降低不明显。未来的研究需要评估RAS抑制剂对特定肾移植患者群体中同种异体移植物存活的潜在益处。
