ANGIOTENSIN II RECEPTOR BLOCKER INHIBITOR USE AFTER KIDNEY TRANSPLANTION AND SAFETY: A RANDOMIZED, DOUBLE-BLINDED PLACEBO-CONTROLLED STUDY

Abstract

Introduction: End stage Renal disease is chronic irreversible renal failure that needed renal replacement therapy and Kidney transplantation in most patiens is the best modality.In transplant centers improvement in graft and patient survival after transplantation is purpose. Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in CKD patients decrease in blood pressure, albuminuria and glomerulosclerosis but data insufficient about their safety in kidney transplant recipients.hyperkalemia and decrease in GFR are most worrisome. In this study we evaluate the safety of ARBs(Losartan)in post transplant. Methods: In this double blinded placebo control trial 70 candidates of first living kidney transplant from November 2013 to December 2015 in Labbafinejad Hospital enrolment 24 were excluded only 54 patients randomly divided .6 days after transplantation 27 patients in group 1 received Losartan 25 mg daily and group 2 placebo until 6 and 12 months post transplant. Whole blood sample before initiation of drug and 6 months later were collected. Kidney biopsy after 6 months in all patients were done. Results: In 54 patients randomized Mean age of patients in losartan group was 42.84 ± 9.2 and in the control group was 35.22 ± 10.4 (p>0.05). Mean donor age was not significantly different with the groups. (31.47 vs. 26.66 years; p>0.05). During the study, there was no significant differences in blood pressure, eGFR, potassium level, and hemoglobin level between the two groups. (Table-2). The difference in eGFR was not significant even at 12 months after transplantation. (72.7 vs 70.9 cc/min in case and control group, respectively; P>0.05).Discussion: According to the results potassium, hemoglobin,AST, ALT and GFR levels did not differ significantly between the groups. There is not different in graft failure incidence and, death in groups. We can successfully use ARBs without risk in the post-kidney transplant period, and benefited from long-term beneficial effects on renal function.