Lauren Andrews, BCCCP, PharmD
Critical Care Infectious Diseases Pharmacotherapy Fellow
University of Illinois at Chicago
Chicago, Illinois
Disclosure information not submitted.
Jamie Benken, PharmD, BCPS
Clinical Pharmacist - Organ Transplant
University of Illinois at Chicago College of Pharmacy
Chicago, Illinois, United States
Disclosure information not submitted.
Enrico Benedetti, MD
Physician - Department of Transplant Surgery
University of Illinois Hospital & Health Sciences System
Chicago, Illinois, United States
Disclosure information not submitted.
Hokuto Nishioka, MD
Physician - Department of Anesthesiology
University of Illinois Hospital & Health Sciences System
Chicago, Illinois, United States
Disclosure information not submitted.
Kaitlyn Dalton, PharmD
PGY2 Pharmacy Resident - Critical Care
University of Illinois at Chicago College of Pharmacy
Chicago, Illinois, United States
Disclosure information not submitted.
Dana Pierce, PharmD
PGY2 Pharmacy Resident - Organ Transplant
University of Illinois at Chicago College of Pharmacy
Chicago, Illinois, United States
Disclosure information not submitted.
Justin Han, n/a
Pharmacy Student
University of Illinois at Chicago College of Pharmacy
Chicago, Illinois, United States
Disclosure information not submitted.
Bona Shin, n/a
Pharmacy Student
University of Illinois at Chicago College of Pharmacy
Chicago, Illinois, United States
Disclosure information not submitted.
Scott Benken, BCPS, PharmD
Pharm D
University of Illinois Health Sciences and Medical Center
Chicago, Illinois
Disclosure information not submitted.
Title: Angiotensin II in the Perioperative Management of Hypotension in Kidney Transplant Recipients
Introduction:
Due to the predominant mechanism of conventional vasopressor catecholamines, there is increased risk for injury and failure of newly transplanted renal allografts in recipients with fluid-refractory distributive shock during the perioperative period. To prevent inadvertent vasoconstriction of the afferent arteriole and subsequent renal hypoperfusion, it is hypothesized that first-line use of angiotensin II (ATII) in the intraoperative and postoperative setting may lead to improved hemodynamic efficacy and safety compared to current standards of care.
Methods:
Prospective, observational pilot study of 20 consecutive adult kidney transplant recipients who required perioperative vasopressor therapy at a tertiary care, academic medical center in Chicago, Illinois. Enrollment was limited to subjects with a pre-transplant ejection fraction of ≥50%, without history of mesenteric ischemia, aortic dissection, abdominal aortic aneurysm, Raynaud’s phenomenon, systemic sclerosis, or vasospastic disease. Primary endpoint was defined as time to goal systolic blood pressure (SBP) of ≥120 mmHg. Secondary endpoint was defined as incidence of adverse events (ADEs). ATII was initiated at 20 ng/kg/min and titrated by ±5 ng/kg/min, with adjunct vasopressor therapy utilized as needed per standard of care.
Results:
Majority of cases consisted of deceased donor renal transplants (70%) with a mean cold ischemia time of 14.7 ±8.6 hours. Population was similarly matched in gender and aged 56 ±11 years old, with body mass index and total body weight of 33.2 ±6.8 kg/m2 and 95.1 ±24.2 kg, respectively. Subjects received 3.2 ±2.0 L of volume resuscitation over an average transplant surgery time of 5.3 ±1.2 hours. Utilizing duration of ATII infusion as a surrogate marker, median time to goal SBP was 1.63 hours (IQR, 2.88 hours) intraoperatively. No negative safety outcomes were determined to be directly related to ATII, however, the most commonly reported ADE was hyperglycemia requiring insulin infusion therapy at an incidence rate of 25%. Additional ADEs occurred in ≤2 out of 20 subjects, including delayed graft function, thrombocytopenia, arrhythmia, and peripheral ischemia.
Conclusions:
ATII may be utilized as a safe and effective first-line vasopressor for perioperative hypotension in kidney transplant recipients.