A Double Blind Randomized Clinical Trial of Remote Ischemic Conditioning in Live Donor Renal Transplantation.
Nicholson ML, Pattenden CJ, et al.Medicine (Baltimore) 2015; 94(31): e1316
Aims
To determine whether remote ischemic conditioning (RC) is effective in improving renal function in adults undergoing live donor kidney transplantation
Interventions
Recipients had an arterial tourniquet cuff placed around the thigh contralateral to the side of the transplant operation. Those randomised to RC received four 5-min cycles of blood pressure cuff inflation to 200 mm Hg or systolic blood pressure plus 25 mm Hg (whichever was higher), interrupted by 5 min cycles of reperfusion by blood pressure cuff deflation. The control group received four 5-min cycles of 25 mm Hg followed by 5 min deflation.
Participants
80 adult patients ≥ 18 years receiving live donor kidney transplantation.
Outcomes
The primary outcome was estimated glomerular filtration rate (eGFR). Secondary outcomes measured were renal function, primary nonfunction, delayed graft function, slow graft function, creatinine reduction ratio day 2 posttransplant, > 50% fall in serum creatinine in the first 24 h, biopsy-proven acute rejection and graft failure.
Follow-up
3 months
CET Conclusions
This is a perfectly conducted double blind RCT in which remote ischaemic conditioning conducted in the leg of live donor recipients in four 5 minute cycles before revascularisation of the kidney did not result in any difference in renal function at 1 and 3 months after transplantation. As the authors point out their results and conclusions only apply to the protocol of RC used in this study and other studies using different conditioning protocols are required.
Data analysis
Strict intention-to-treat analysis
Trial registration
Clinical Trial Registration - ISRCTN66437627