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The effect of α‐human atrial natriuretic peptide on the incidence of acute renal failure in cadaveric kidney transplantation

Abstract. In previous studies in humans, mannito (20%, 250 ml) has been shown to reduce the in cidence of acute renal failure (ARF) after transplan tation from 54% to 19%. In rats, atrial natriuretic peptide appears to prevent ischemia‐induced ARF We therefore decided to evaluate the effects of α‐human atrial natriuretic peptide (α‐h‐ANP) both alone and combined with mannitol during transplantation in humans. First, we demonstrated thai systemic α‐h‐ANP infusion during kidney transplantation was safe in dosages up to 0. 08 μg/kg pei minute. In these patients the calculated metabolic clearance rate of α‐h‐ANP was relatively low ranging from 0. 68 to 1. 801/min. In a second study of 11 renal graft recipients, no mannitol was used and α‐h‐ANP (0. 05 μg/kg per minute) was infused into the donor kidney artery during transplantation for 46 ± 2min, followed by IV administration for 71 ± 2 min. Our aim was to reduce the incidence of ARF. Nevertheless, ARF occurred immediately after surgery in four of the patients (36%) in this group and, as a result, mannitol was reintroduced. A third group of nine renal graft recipients received α‐h‐ANP (total dose 400 μg) as five IV injections within 90 min after transplantation. ARF occurred in four of these patients (44%). We conclude that α‐h‐ANP, administered according to the aforementioned protocols in such small groups of patients, does not seem to be of value in the prevention of ARF after transplantation.