Angiotensin Receptor Blockade Does Not Decrease Synthetic Angiotensin II (Giapreza^®) Effectiveness in Perioperative...

Area of Science:

• Nephrology
• Cardiology
• Pharmacology

Background:

• Theoretical concerns exist regarding angiotensin II (AT2S) use as a vasopressor in kidney transplant (KT) patients already on angiotensin receptor blockers (ARBs).
• AT2S is the standard first-line vasopressor at our center for peri-transplant management.
• This study investigates the impact of pre-transplant ARB use on AT2S efficacy and safety during KT.

Purpose of the Study:

• To evaluate the hemodynamic and clinical effects of pre-transplant ARBs on the use of AT2S in kidney transplant recipients.
• To compare outcomes between patients on ARBs and those not on ARBs when receiving AT2S.
• To determine if pre-existing ARB therapy alters the response to AT2S during KT.

Main Methods:

• Single-center, retrospective cohort study.
• Inclusion criteria: patients aged ≥18 years with hypertension on antihypertensive therapy receiving AT2S as first-line vasopressor peri-transplant.
• Comparison between patients on ARBs (n=22) and non-ARBs (n=43).

Main Results:

• No significant differences were observed in the total duration of AT2S use between the ARB and non-ARB groups.
• The frequency and duration of systolic blood pressure (SBP) < 120 mmHg did not differ significantly between groups.
• Need for additional vasopressor support, hospital/ICU length of stay, safety, and adverse events were similar across both cohorts.

Conclusions:

• Pre-transplant ARB use did not lead to significant adverse hemodynamic or clinical outcomes in patients requiring AT2S during kidney transplantation.
• Findings contradict theoretical concerns and observations in other shock populations.
• The study supports the continued use of AT2S as a first-line vasopressor in KT patients, irrespective of pre-transplant ARB therapy.