Angiotensin Receptor Blockade Does Not Decrease Synthetic Angiotensin II (Giapreza®) Effectiveness in Perioperative Hypotension Surrounding Kidney Transplant

TL;DR

This study found that using angiotensin II as a vasopressor during kidney transplants is equally effective in patients taking ARBs as in those who are not.

Contribution

The study challenges theoretical concerns by showing no difference in angiotensin II effectiveness in ARB users during kidney transplants.

Findings

No significant differences in SBP < 120 mmHg frequency or duration between ARB and non-ARB groups.

Additional vasopressor requirements were similar in both groups.

Hospital and ICU stay length, safety, and adverse events were comparable between groups.

Abstract

Background/Objectives: The use of angiotensin II (AT2S) as a vasopressor in patients receiving angiotensin receptor blockers (ARBs) prior to kidney transplant (KT) raises theoretical concerns. At our center, AT2S is the first-line vasopressor during KT. This study evaluated the hemodynamic and clinical effects of pre-transplant ARBs on AT2S use in KT. Methods: This single-center, retrospective cohort trial included patients with hypertension ≥ 18 years old on antihypertensive therapy who received AT2S as the first-line vasopressor peri-transplant. Patients were divided into ARB and non-ARB cohorts. Primary outcomes included total AT2S duration, time with SBP < 120 mmHg, and need for additional vasopressor support. Results: A total of 65 patients were analyzed: 22 in the ARB group and 43 in the non-ARB group. There were no significant differences in the frequency or duration of SBP < 120 mmHg or additional vasopressor requirements between groups (p > 0.05). Hospital and ICU stay length, safety, and adverse drug events were also similar. Conclusions: Contrary to theoretical concerns and observations in other distributive shock populations, no significant hemodynamic or clinical differences were observed in the response to AT2S in patients with pre-transplant ARB use.

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