What is the role of synthetic angiotensin II (Giapreza®/AT2S) in the peri-operative management of kidney transplantation?

Label:chem

Topic
Perioperative hypotension during kidney transplantation increases the risk of graft dysfunction and loss. AT2S is a synthetic vasoconstrictor that targets the renin-angiotensin-aldosterone system (RAAS) and has been proposed as a first-line agent to maintain blood pressure in this setting.
Answer
AT2S was used as the first-line continuous vasopressor for hypotension (SBP < 120 mmHg) during and after kidney transplantation. It was started at 20 ng/kg/min and titrated up to 80 ng/kg/min in the first 3 h, then a maximum of 40 ng/kg/min thereafter. The drug was effective in both Black and non-Black cohorts, with no difference in the total amount of AT2S administered (15.2 ± 28.4 vs. 13.0 ± 16.5 ng/kg/min, p = 0.384) or in the incidence of breakthrough hypotensive episodes. AT2S was not associated with increased tachyarrhythmias or thrombotic events.
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