Korean J Transplant.  2022 Nov;36(Supple 1):S168. 10.4285/ATW2022.F-2935.

Should we discontinue angiotensin converting enzyme inhibitor and angiotensin receptor blocker before kidney transplantation?

• Baek CH
• Kim H
• Park SK

• KMID: 2535684
• DOI: http://doi.org/10.4285/ATW2022.F-2935

Abstract

Background
Angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) are usually recommend-ed to stop before surgery to prevent postoperative acute kidney injury. However, it is uncertain that ACEi and ARB should be dis-continued before kidney transplantation (KT). Therefore, we investigated the effect of pre-KT administration of ACEi and ARB on the outcomes of KT.
Methods
We reviewed patients who received living-donor KT in our tertiary center between 2018 and 2020. Among 923 patients, 291 patients continued ACEi/ARB within 3 days before KT (ACEi/ARB group), and 632 patients did not take ACEi/ARB within 3 days before KT (no ACEi/ARB group). Delayed graft function, hyperkalemia events, slope of creatinine after KT, rejection and graft survival were compared between two groups.
Results
Baseline characteristics were not significantly different between two groups except medical history of hypertension (96.2% in ACEi/ARB group vs. 90.2% in no ACEi/ARB group, P=0.001). The numbers of ABO incompatible KT or HLA-sensitized KT, the degree of HLA mismatches and immunosuppressant were not different significantly between two groups. Delayed graft function occurred in two (0.7%) patients in ACEi/ARB group and 13 (2.1%) patients in no ACEi/ARB group (P=0.165). The event of hyperkalemia (K>5.5 mEq/L) did not happen more frequently in ACEi/ARB group (21.3% vs. 22.9%, P=0.611, the day before KT; 11.3% vs. 10.1%, P=0.566, the day of surgery; 0.3% vs. 0.3%, P=1.000, the day after surgery). The slopes of creatinine from post-operative day 0 to day 7 were similar in two groups (–0.732±0.349 vs. –0.751±0.325, P=0.435). Rejection-free survival and graft survival were not significantly different between two groups (P=0.890 and 0.619 by log-rank test, respectively).
Conclusions
Use of ACEi/ARB before KT did not increase the incidence of delayed graft function, hyperkalemia and rejection. Also, renal function improvement after KT was not affected by the use of ACEi/ARB before KT. Therefore, ACEi/ARB might not give significant impact on the outcomes of KT.