Ischemic postconditioning in human DCD kidney transplantation is feasible and appears safe.
Ischemic postconditioning may improve outcome after kidney transplantation. We performed a pilot study to assess feasibility and safety of ischemic postconditioning in human donation-after-circulatory-death kidney transplantation. Twenty patients were included. Primary outcome was rate of serious adverse events. Secondary outcomes were incidence of DGF and renal function at 3 months. Data were compared to a historical control group (n = 40). Furthermore, we performed a paired kidney analysis using the contralateral kidney (n = 11). Donor age and serum creatinine were higher in the experimental group compared with historical control: 57.7 (20-71) vs. 51.5 (24-74) years (P = 0.01) and 79 (40-156) μmol/l vs. 64 (25-115) μmol/l (P = 0.047). Postconditioning could be applied all times. One complication, a venous tear, occurred related to postconditioning. The experimental group experienced more DGF (85% vs. 63%) (P = 0.07). Serum creatinine at month 3 was 166 (109-331) μmol/l vs. 159 (81-279) μmol/l (P = 0.71). Paired kidney analysis showed no significant differences in DGF (72.2% vs. 54.5%, P = 0.66) and serum creatinine 199 (90-473) μmol/l vs. 184 (117-368) μmol/l (P = 0.76). This is the first report of applying IPoC in human kidney transplantation. Although IPoC is feasible and appears to be safe, no benefit in terms of reduced DGF or better renal function was observed (Dutch trial registry number NTR 3117).
Department of Surgery, division of Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Eline K
EK
van den Akker
Dennis A
DA
Hesselink
Olivier C
OC
Manintveld
Jeffrey A
JA
Lafranca
Ron W F
RW
de Bruin
Willem
W
Weimar
Jan N M
JN
Ijzermans
Frank J M F
FJ
Dor
D000328:Adult; D000367:Age Factors; D000368:Aged; D000465:Algorithms; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D057775:Ischemic Postconditioning / Q000379:methods*; D007668:Kidney / Q000473:pathology; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011184:Postoperative Period; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
D007166:Immunosuppressive Agents; D003404:Creatinine
DCD; clinical trial; feasibility; human; ischemic postconditioning; kidney transplantation