ANGIOTENSIN-CONVERTING ENZYME GENOTYPE AND RENAL-ALLOGRAFT SURVIVAL

Increased activity of the renin-angiotensin system has been implicated in decreased, long-term survival of renal allografts. Recent studies suggest that a deletion variant of the angiotensin-converting enzyme, associated with increased humoral and tissue activity of this enzyme, is a risk factor for the development of diabetic nephropathy and the p rogression of IgA nephropathy. To determine whether the deletion varia nt of the angiotensin-converting enzyme gene influences the longterm o utcome in renal transplant recipients, the relationship between donor and recipient angiotensin-converting enzyme genotype and clinical outc ome were examined over a follow-up period up to 30 mo in a cohort of 2 69 Caucasian patients undergoing kidney transplantation between 1988 a nd 1993. In a subsequent case control study, the frequencies of the an giotensin-converting enzyme genotype were compared in a group of Cauca sian patients with a graft survival of less than 3 yr (mean survival, 11 mo; n = 328) with the frequencies in patients with a graft survival of at least 3 yr (mean survival, 65 mo, n = 461). Neither in the coho rt nor in the case control study was there a significant effect of rec ipient or donor angiotensin-converting enzyme genotype on transplant s urvival. Furthermore, the frequency of the angiotensin-converting enzy me deletion allele both in recipients and donors was similar to that r eported in Caucasian controls. This study, therefore, does not support the hypothesis that the recipient or donor angiotensin-converting enz yme insertion/deletion polymorphism is an important determinant of tra nsplant survival in Caucasian patients undergoing renal transplantatio n.