Effect of remote ischemic postconditioning on patients undergoing living donor liver transplantation

Abstract

The aim of this study was to evaluate the protective effect of remote ischemic postconditioning (RIPostC) on graft function and acute kidney injury (AKI) after living donor liver transplantation (LT). Recipients undergoing elective living donor LT were randomly assigned to either the RIPostC group or the control group. Immediately after reperfusion, 4 cycles of ischemia and reperfusion lasting for 5 minutes each were performed on 1 upper limb in the RIPostC group. Graft function was assessed through evaluations of the serum levels of total bilirubin and liver enzymes and the prothrombin time for 28 days after surgery. The incidence of AKI, as defined by the Risk, Injury, Failure, Loss, and End-Stage Kidney Disease classification, was evaluated within 28 days of the operation. In addition, the incidences of graft dysfunction, acute cellular rejection, and major complications; the 1-, 3-, and 6-month mortality rates; the length of stay in the intensive care unit; and the length of hospital stay were also investigated. In all, 78 patients were enrolled in the analysis (n 5 39 in each group). No differences in graft function or clinical outcomes were observed between the groups. The incidences of postoperative AKI were 38% (n 5 15) in the RIPostC group and 72% (n 5 28) in the control group (P 5 0.006). Despite no improvements in postoperative graft function, RIPostC decreased the incidence of postoperative AKI after living donor LT in this study. However, no other clinical benefits with respect to the complication rate, length of hospital stay, or short-term mortality rate were observed. Thus, further studies will be needed to evaluate the clinical efficacy of RIPostC in LT fully.

Local and systemic coagulation marker response to musculocutaneous flap ischemia–reperfusion injury and remote ischemic conditioning: An experimental study in a porcine model

“…The diverging results could be explained by the fact that we used a porcine model with an ischemic event in contrast to healthy men with no ischemic event. Furthermore, RIC did not affect postoperative PT and international normalized ratio (INR) in a randomized controlled trial on living donor liver transplantation (Kim et al, 2014). However, RIC increased PT and INR when administered repeatedly in patients hospitalized for aneurysmal subarachnoid hemorrhage, Thrombin generation in systemic blood samples from the control and intervention group during reperfusion: lag time, time-topeak, peak thrombin, and endogenous thrombin potential (ETP) presented as means with SD.…”

Limb Remote Ischemic Postconditioning Reduces Ischemia-Reperfusion Injury by Inhibiting NADPH Oxidase Activation and MyD88-TRAF6-P38MAP-Kinase Pathway of Neutrophils

“…LRIP is easy for operation, while its mechanisms are unclear [36,37]. The role of inflammation and oxidative damage on stroke and cardiovascular disease pathogenesis is very important and has been studied by lots of researchers [20,21,38,39].…”

Ischaemic conditioning reduces kidney injury in an experimental large-animal model of warm renal ischaemia

“…They showed an improvement in GFR and renal perfusion in the experimental group, although the animals were recovered for only 10 h. These authors also measured haem oxygenase 1 and NGAL excretion and inflammation markers, but demonstrated no difference between the groups, which may be due to the short recovery period 27 . Two randomized studies 28,29 comparing living donor transplant recipients have shown that IC has no effect on renal function. This could be explained by the minimal ischaemic injury sustained by the organs.…”