WCN25-3766 SAFETY OF LOW DOSE ACE INHIBITION IN LIVING KIDNEY DONORS : A PILOT STUDY

syndrome (PCOS), hypertension, migraines and end-stage renal disease (ESRD) due to oxalate nephropathy, who underwent a living unrelated donor kidney transplant.Semaglutide (initially 0.25 mg, escalated to 0.5 mg) was initiated 6 months prior to transplant, following which the patient had a weight loss of 10-15 kg to be transplant eligible.She received induction immunosuppression with Thymoglobulin with a rapid steroid taper and maintenance immunosuppression with mycophenolate and tacrolimus was initiated on post op day 2.She had experienced immediate graft function and was discharged on postoperative day 3.One week posttransplant, she was admitted with acalculous gangrenous cholecystitis without systemic bacteremia or identifiable sources of bacterial seeding to gallbladder.Initial management included conservative treatment with antibiotics, temporary suspension of Semaglutide and cholecystostomy tube placement, followed by cholecystectomy six weeks later.Given the absence of an identifiable source for the cholecystitis, it was attributed to bile stasis from GLP-1 RA use, especially considering her recent weight loss and the higher dosage.Results: Our findings align with a meta-analysis by Liyun He et al., which indicated an increased incidence of biliary tract disease in patients using GLP-1 RAs for obesity and type 2 diabetes, particularly with higher doses and recent weight loss.The initiation of immunosuppression in the perioperative period may heighten the risk of infectious complications, such as acalculous cholecystitis.Conclusions: In conclusion, the increased incidence of biliary tract disease associated with GLP-1 RA use necessitates heightened awareness among healthcare providers, particularly for patients undergoing kidney transplants.A low threshold for suspicion of biliary infections should be maintained in these cases.Further studies are warranted to explore the relationship between GLP-1 RA therapy and biliary tract disease in the early post-transplant period.I have no potential conflict of interest to disclose.I used generative AI and AI-assisted technologies in the writing process.During the preparation of this work the author(s) used perplexity.ai in order to improve readability.After using this tool/service, the author(s) reviewed and edited the content as needed and take(s) full responsibility for the content of the publication.