Comparison of the effects of enalapril and losartan on posttransplantationerythrocytosis in renal transplant recipients - Prospective randomized study

Background. The aim of this prospective randomized study was to compare the safety and efficacy of enalapril (E) and losartan (L) in the treatment of posttransplantation erythrocytosis and the effect of the ACE genotype on re sponse to therapy. Methods. Twenty-seven (24 male and 3 female, mean age 34 +/- 8 years) renal transplant recipients with erythrocytosis were treated either with E (15 p atients) (10 mg/day) or L (12 patients) (50 mg/day) for 8 weeks. Results. The hemoglobin levels were significantly decreased in the L (17.1 +/- 0.7 to 15.9 +/- 1.3 g/dl, P = 0.01) and E groups (17.4 +/- 1.1 to 14.9 +/- 2.2 g/dl, P = 0.001). Among the responders who discontinued treatment, there was a trend for longer time to relapse in the L group (7.38 +/- 3.75 months; 95% confidence interval: 0.03-14.7) compared with the E group (2.75 +/- 0.70 (95% confidence interval: 1.37-4.13) (P = 0.11). Decrease in hemo globin was more prominent with E compared with L (-3.26 +/- 0.65 vs. -1.70 +/- 0.39 g/dl, P = 0.05). Decrease in hemoglobin levels between DD and non- DD genotype groups was similar (-2.0 +/- 1.5 vs. -1.7 +/- 2.3 g/dl, P = 0.6 9). Conclusions. Enalapril caused a greater decrease but faster relapse in hemo globin levels compared with losartan in patients with posttransplantation e rythrocytosis. The DD type polymorphism had no effect on response.