Transplant Trial Watch

Effects of low versus standard pressure pneumoperitoneum on renal syndecan-1 shedding and VEGF receptor-2 expression in living-donor nephrectomy: a randomized controlled study

Aditianingsih, D., et al.

BMC Anesthesiology 2020; 20(1): 37.


Aims
The aim of this study was to examine the effect of low pressure pneumoperitoneum on renal tubular cells and vascular endothelium in patients undergoing transperitoneal laparoscopic living donor nephrectomy

Interventions
Patients were randomized to either the standard (12mmHg) group or the low pressure (8 mmHg) group.

Participants
44 patients undergoing transperitoneal laparoscopic donor nephrectomy

Outcomes
The primary endpoint was the assessment of serum plasma levels and tubule syndecan-1 expression. The secondary endpoints were expression of VEGFR-2 and sVEGFR-2 (soluble VEGFR-2) in renal tubuloendothelial cells, and levels of urinary KIM-1 and plasma interleukin-6 (IL-6).

Follow-up
1 year

CET Conclusions
The small single-center study investigated the impact of low-pressure pneumoperitoneum (8 vs. 12 mmHg) during laparoscopic donor nephrectomy. The authors demonstrate significantly lower markers of inflammation and renal tubular injury with lower pressures. The clinical significance of these findings are uncertain – there were no differences in operative or other patient outcomes despite the changes in molecular markers. However, lower pressures did not seem to lead to an increase in operative complications or time, suggesting that the majority of procedures could be managed using lower pressures.

Jadad score
3

Data analysis
Strict intention-to-treat analysis

Allocation concealment
Yes

Trial registration
ClinicalTrials.gov - NCT03219398

Funding source
Non-industry funded