Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: The impact of chronically administered medications for renin-angiotensin-aldosterone blockade (e.g. ACE-I, ARB), taken prior to kidney transplant (KTx), on immediate allograft function is unknown.
*Methods: A single center retrospective chart review was conducted on consecutive adult KTx or kidney-pancreas (KP) recipients transplanted between 12/2018- 6/2019. Patients were compared according to the use of an ACE-I/ARB vs none in the immediate pre-transplant period. No patients were maintained on ACE-I/ARB after KTx. Exclusion criteria were: HIV infection, extra-renal transplants other than KP, history of FSGS, all-cause graft loss < 30 days. Allograft function was analyzed within the first wk post-transplant to assess DGF incidence, serum creatinine (SCr) levels, and incidence of hyperkalemia (defined as potassium level > 5.5 mmol/L). Use of an ACE-I/ARB was assessed by documentation in an admission medication reconciliation completed by a pharmacist.
*Results: Of 119 recipients assessed, 48 (40%) had an ACE-I/ARB documented on an admission medication reconciliation. Key demographics were similar between the groups (Table 1) (p=NS), including deceased donation rates, KDPI scores, and cold ischemia times. DGF occurred in 6 (12.5%) recipients in the ACE-I/ARB cohort, and 17 (23.9%) recipients in the no ACE-I/ARB group (p=NS). Change in SCr from pre-transplant baseline during the first post-transplant week for both groups is shown in Figure 1 (excluding DGF patients) (p=NS). Hyperkalemia occurred in 9 (19%) of the ACE-I/ARB patients and 17 (24%) of the non-ACE-I/ARB group (p=NS), mostly within the first 24 hours post-transplant (44% vs 65%, p=NS).
*Conclusions: Recovery of kidney function and serum potassium levels after transplant do not appear to be adversely impacted in recipients taking ACE-I/ARB therapy immediately prior to KTx, compared to recipients not taking these medications. Based on our results, identification of ACE-I/ARB therapy during pre-transplant pharmacy medication reconciliation may not impact immediate graft function after KTx.
To cite this abstract in AMA style:Bohan GR, Trofe-Clark J, Fallah T, Norris M, Bloom RD, Sawinski D, Malat G. Use of Angiotensin Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers Therapy Prior to Kidney Transplantation Does Not Impact Recovery of Function [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/use-of-angiotensin-converting-enzyme-inhibitors-and-angiotensin-ii-receptor-blockers-therapy-prior-to-kidney-transplantation-does-not-impact-recovery-of-function/. Accessed May 18, 2021.
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