Peri-transplant aminophylline in pediatric kidney transplant recipients of donation after brain death: a double-blinded placebo-controlled randomized clinical trial

Orly Haskin*, Weiwen Shih, Cynthia J. Wong, David M. Axelrod, Paul C. Grimm

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: During kidney transplantation, the transplanted kidney undergoes ischemia reperfusion injury, with adenosine being a major mediator. This study aimed to assess whether aminophylline, an adenosine receptor antagonist, improves early graft function and reduces incidence of delayed graft function (DGF) and slow graft function (SGF). Methods: Single center, double-blinded, placebo-controlled randomized clinical trial. Pediatric patients admitted for renal transplantation from donation after brain death donors were randomized into a treatment arm receiving aminophylline and a placebo arm receiving normal saline infusions. Primary outcome was estimated glomerular filtration rate (eGFR) at 5 days post-transplant. Secondary outcomes were rates of DGF/SGF and urinary neutrophil gelatinase–associated lipocalin (NGAL) levels. Results: Twenty-three patients were randomized to aminophylline and 27 to placebo. There was no difference in day 5 eGFR, rate of DGF/SGF, or urine NGAL/Creatinine level between aminophylline vs. placebo arm (eGFR 67.39 ± 38.9 ml/min/1.73m2 vs. 80.48 ± 52.1 ml/min/1.73m2p = 0.32; DGF/SGF 5/23 (21.7%) vs. 3/27 (11.1%) p = 0.31; urine NGAL/creatinine 300.5 ng/mg IQR 105.5–1464.5 ng/mg vs. 425.4 ng/mg IQR 140.3–1126.2 ng/mg, p = 0.95; respectively). At 12 months, there was 100% patient survival and 98% graft survival. eGFR at 12 months was similar between the two arms. Conclusions: There was no benefit in peri-transplant aminophylline administration. Our results are limited by small sample size, since sample calculations were based on primary outcome of day 5 eGFR and low rate of DGF/SGF, which may have precluded us from demonstrating efficacy. Further clinical studies are necessary to determine any benefit of aminophylline in kidney transplant recipients, particularly from high-risk donors.

Original languageEnglish
Pages (from-to)1729-1736
Number of pages8
JournalPediatric Nephrology
Volume35
Issue number9
DOIs
StatePublished - 1 Sep 2020
Externally publishedYes

Funding

FundersFunder number
Lucile Packard Foundation for Children’s Health PTA11130197-119-JHADL
National Center for Research ResourcesUL1RR025744

    Keywords

    • Aminophylline
    • Delayed graft function
    • Kidney transplant
    • Pediatrics

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