Key result
Pre-transplant ARB use shows no association with hemodynamic outcomes or vasopressor requirements after kidney transplantation.
Why the study?
The hemodynamic and clinical effects of pre-transplant angiotensin receptor blocker use on synthetic angiotensin II vasopressor effectiveness in kidney transplant patients were uncertain.
Does pre-transplant ARB use decrease the effectiveness of synthetic angiotensin II as a perioperative vasopressor in kidney transplant patients?
Cohort (n=65)
No
Does pre-transplant ARB use decrease the effectiveness of synthetic angiotensin II as a perioperative vasopressor in kidney transplant patients?
p-value: p=> 0.05
Pre-transplant use of angiotensin receptor blockers does not appear to decrease the hemodynamic effectiveness of synthetic angiotensin II used as a perioperative vasopressor during kidney transplantation.
AT2S remains feasible despite pre-transplant ARBs in KT; hypothesis-generating and leaves open prospective confirmation.
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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Benken et al. (2025) conducted a cohort in Perioperative hypotension surrounding kidney transplant (n=65). Pre-transplant Angiotensin Receptor Blockers (ARBs) vs. Non-ARB use was evaluated on Total AT2S duration, time with SBP < 120 mmHg, and need for additional vasopressor support (p=> 0.05). Pre-transplant ARB use did not significantly affect the frequency or duration of SBP < 120 mmHg or additional vasopressor requirements in kidney transplant patients receiving angiotensin II (p > 0.05).
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