The effect of remote ischemic post-conditioning in patients undergoing living donor liver transplantation.
Kim WH, Lee JH, et al.Liver Transplantation 2014; 20(11): 1383-1392
Aims
To investigate the protective effect of remote ischemic post-conditioning (RIPostC) after living donor liver transplantation on graft function and acute kidney injury (AKI).
Interventions
Patients were randomised to the RIPostC or control group. In the RIPostC group, following reperfusion of the transplanted liver, four cycles of cuff inflation for five minutes and deflation for five minutes were performed with a pressure of 200mmHg. The control group received the same intervention however there was a difference in the pressure.
Participants
78 patients scheduled for elective living donor transplantation.
Outcomes
The primary outcome was the level of aspartate aminotransferase (AST). The secondary outcomes included post-transplant graft function and the incidence of post-operative AKI.
Follow-up
28 days
CET Conclusions
AST in the post-operative period is described as the primary outcome, but is not described in any detail in the results section. Serum ALT and AST were used as surrogate outcomes as the study was not powered for clinical outcomes. The results section declares that the maximal ALT in the first 28 days was significantly lower in the RIPostC group, yet it also declares that there were no significant differences in biochemical markers at any time after transplantation, which is a little confusing. More kidneys developed AKI at the “Risk†level in the control group than the RIPostC group (as defined by RIFLE criteria). There was no difference in numbers of AKI at the “Injury†or “Failure†levels. There were no knock-on effects on complication rate, length of stay or short-term mortality.
Data analysis
Modified intention-to-treat analysis
Trial registration
ClinicalTrials.gov – NCT01637038