Angiotensin blockade is associated with early graft dysfunction after live donor renal transplantation.
BACKGROUND
Activation of the renin angiotensin system may contribute to the development of delayed graft function after renal transplantation. We, therefore, examined the impact of pretransplant treatment with blockers of the renin angiotensin system on early graft function after renal transplantation.


METHODS
The case records of all patients who received a live donor transplant between January 2001 and August 2008 were reviewed.


RESULTS
Serum creatinine measurements were recorded for the first nine posttransplant days, in 94 recipients of live donor kidneys, where there were neither surgical nor hemodynamic complications and no documented rejection or infection. Forty patients (43%) were treated with a blocker of the renin-angiotensin-aldosterone system before transplantation. Serum creatinine levels fell more slowly in these patients (P=0.02). Two patients required hemodialysis after transplantation; both were on an angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker.


CONCLUSIONS
Live donor renal transplant recipients who are taking a renin-angiotensin-aldosterone system blocker at the time of transplantation are more likely to have impaired graft function postoperatively in the absence of other explanations. This observation requires further exploration in live and deceased donor renal transplantation.
Stevens
Kathryn K
KK
Renal Transplant Unit, Western Infirmary, Glasgow, United Kingdom. kathrynstevens2@nhs.net
Patel
Rajan K
RK
Clancy
Marc
M
Jardine
Alan G
AG
D000293:Adolescent; D000328:Adult; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D051799:Delayed Graft Function / Q000209:etiology* / Q000378:metabolism / Q000628:therapy; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D006435:Renal Dialysis; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D015415:Biomarkers; D003404:Creatinine