The effect of remote ischemic post-conditioning on graft function in patients undergoing living donor kidney transplantation.
Kim WH, Lee JH, Kim GS, et al.Transplantation; 98(5): 529-536
Aims
To investigate whether remote ischemic post-conditioning (RiPoc) improves graft function in living donor kidney transplant recipients.
Interventions
The experimental group received RiPoc immediately after reperfusion of the transplanted kidney. RiPoc consisted of three 5 minute cycles of upper limb ischemia performed with an automated pneumatic cuff inflator placed on the upper limb without the arteriovenous fistula. The control group patients received a deflated cuff on their upper limbs for 30 minutes.
Participants
60 patients undergoing living donor kidney transplantation.
Outcomes
The study outcomes were estimated glomerular filtration rate (eGFR), creatinine clearance, urine output, acute rejection, delayed graft function and length of total and postoperative hospital stay.
Follow-up
1 year.
CET Conclusions
This is a well conducted study in a small number of live donor kidney recipients. In the first 24 hours after transplantation, Remote Ischaemic Post-Conditioning (RiPoC) did seem to have an effect on renal function, however this was no different to controls from 24 hours onwards. At 36 hours 93% of kidneys had a 50% reduction in GFR and 86% in the control group. One does have to question the relevance of this study in live donors where the initial function is usually excellent; an increase in day one urine output from over 6 litres on average up to 7 litres is of little importance. There was no difference observed in the rates of delayed function, primary non-function or acute rejection.
Data analysis
Strict intention-to-treat analysis
Trial registration
ClinicalTrials.gov - NCT01363687