title: Does liver ischemic preconditioning in brain death donors induce kidney preconditioning? A retrospective analysis.
abstract: BACKGROUND
  It is unclear whether ischemic preconditioning (IPC) of solid organs induces remote IPC (RIPC) in donors after brain death (DBD).
  
  
  METHODS
  Outcomes in kidney recipients from 163 DBD in two randomized trials of liver IPC (5 min=62 and 10 min=101) were obtained retrospectively from the Scientific Registry of Transplant Recipients. Controls were kidney recipients from donors without IPC. Mean cold ischemia times were less than 20 hr. Primary outcomes were delayed graft function, defined as dialysis during the first posttransplantation week, and death-censored graft survival. Secondary outcomes were duration of initial hospital stay, patient survival, and estimated glomerular filtration rate 6, 12, 36, and 60 months after transplantation.
  
  
  RESULTS
  After exclusions (40 kidneys not recovered, 21 not transplanted, 8 en bloc, 23 with extrarenal organs, and 6 with missing records), 228 recipients were included. Delayed graft function occurred in 23% of No RIPC and 28% of RIPC kidneys (P=0.54). One- and 3-year graft survival rates were 92% and 90%, respectively, in the No RIPC and 90% and 81%, respectively, in the RIPC group (P=0.12), and mean hospital stay was 9.3±13.9 and 9.7±8.2 days, respectively (P=0.15). There were no significant between group differences in patient survival and estimated glomerular filtration rate at any time point.
  
  
  CONCLUSIONS
  Despite design and power limitations, our results suggest that liver IPC in DBD is of no clinical benefit to kidney recipients. Inconsistent efficacy and impracticality severely limit the usefulness of IPC in DBD. Other modalities of preconditioning should be tested.
authors.affiliation: 1 Department of Surgery, Rutgers-New Jersey Medical School, Newark, NJ. 2 Department of Preventive Medicine and Community Health, Rutgers-New Jersey Medical School, Newark, NJ. 3 Address correspondence to: Baburao Koneru, M.D., 185 South Orange Avenue, MSB G-595, Newark, NJ 07101.
authors.forename: Kunj K
authors.initials: KK
authors.lastname: Desai
authors.forename: Cesar
authors.initials: C
authors.lastname: Mora-Esteves
authors.forename: Bart K
authors.initials: BK
authors.lastname: Holland
authors.forename: George
authors.initials: G
authors.lastname: Dikdan
authors.forename: Adrian
authors.initials: A
authors.lastname: Fisher
authors.forename: Dorian J
authors.initials: DJ
authors.lastname: Wilson
authors.forename: Baburao
authors.initials: B
authors.lastname: Koneru
mesh_terms: D000328:Adult; D001926:Brain Death; D051799:Delayed Graft Function / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006801:Humans; D019194:Ischemic Preconditioning / Q000379:methods*; D016030:Kidney Transplantation / Q000379:methods*; D007902:Length of Stay; D008099:Liver / Q000473:pathology*; D016031:Liver Transplantation / Q000379:methods; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D012042:Registries; D051437:Renal Insufficiency / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors; D014019:Tissue Donors; D020858:Tissue and Organ Harvesting / Q000379:methods; D016896:Treatment Outcome