BACKGROUND AND OBJECTIVE: The clinical manifestation of angioedema ranges from minor facial edema up to life-threatening swelling of mouth and throat. Hereditary defects, drugs, and food allergies may play a role in the development of angioedema. We systematically investigated the incidence of angioedema in renal allograft recipients treated with mTOR inhibitors (mTORis). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: All patients in the authors' electronic database who had received mTORis (n = 309) between 2000 and 2008 were identified. Of these, 137 were additionally treated with angiotensin-converting enzyme inhibitors (ACEis). RESULTS: Nine patients (6.6%, 3.8 per 100 treatment years) developed angioedema after a mean period of 123 days under combined therapy with mTORi and ACEi. Among the remaining 172 patients on mTORi, including 119 patients treated with angiotensin-receptor blockers, only two developed angioedema (1.2%, 0.5 per 100 treatment years, P = 0.01). In patients receiving mycophenolate and ACEi (n = 462), 10 instances of angioedema were found (2.1%, 0.8 per 100 treatment years, P = 0.004). CONCLUSIONS: This systematic investigation demonstrated a noticeable incidence of 6.6% angioedema under combined therapy with mTORi and ACEi in kidney transplant recipients. Treatment with either ACEi or mTORi alone resulted in a significantly lower incidence of angioedema, suggesting that this combination should be avoided.
BACKGROUND AND OBJECTIVE: The clinical manifestation of angioedema ranges from minor facial edema up to life-threatening swelling of mouth and throat. Hereditary defects, drugs, and food allergies may play a role in the development of angioedema. We systematically investigated the incidence of angioedema in renal allograft recipients treated with mTOR inhibitors (mTORis). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: All patients in the authors' electronic database who had received mTORis (n = 309) between 2000 and 2008 were identified. Of these, 137 were additionally treated with angiotensin-converting enzyme inhibitors (ACEis). RESULTS: Nine patients (6.6%, 3.8 per 100 treatment years) developed angioedema after a mean period of 123 days under combined therapy with mTORi and ACEi. Among the remaining 172 patients on mTORi, including 119 patients treated with angiotensin-receptor blockers, only two developed angioedema (1.2%, 0.5 per 100 treatment years, P = 0.01). In patients receiving mycophenolate and ACEi (n = 462), 10 instances of angioedema were found (2.1%, 0.8 per 100 treatment years, P = 0.004). CONCLUSIONS: This systematic investigation demonstrated a noticeable incidence of 6.6% angioedema under combined therapy with mTORi and ACEi in kidney transplant recipients. Treatment with either ACEi or mTORi alone resulted in a significantly lower incidence of angioedema, suggesting that this combination should be avoided.
Authors: John B Kostis; Harold J Kim; James Rusnak; Thomas Casale; Allen Kaplan; Jonathan Corren; Elliott Levy Journal: Arch Intern Med Date: 2005-07-25
Authors: Hani Wadei; Scott A Gruber; Jose M El-Amm; James Garnick; Miguel S West; Darla K Granger; Dale H Sillix; Stephen D Migdal; Abdolreza Haririan Journal: Am J Transplant Date: 2004-06 Impact factor: 8.086
Authors: Salim Yusuf; Koon K Teo; Janice Pogue; Leanne Dyal; Ingrid Copland; Helmut Schumacher; Gilles Dagenais; Peter Sleight; Craig Anderson Journal: N Engl J Med Date: 2008-03-31 Impact factor: 91.245
Authors: Lutz Fritsche; Jan Hörstrup; Klemens Budde; Petra Reinke; Markus Giessing; Stefan Tullius; Stefan Loening; Peter Neuhaus; Hans-Hellmut Neumayer; Ulrich Frei Journal: Am J Transplant Date: 2003-11 Impact factor: 8.086