The effect of remote ischemic postconditioning on graft function in patients undergoing living donor kidney transplantation.
BACKGROUND
We evaluated whether remote ischemic postconditioning (RiPoC) could improve initial graft function in living donor kidney transplantation (KT).


METHODS
Patients undergoing living donor KT were randomly assigned to either RiPoC (n=30) or control group (n=30). Immediately after reperfusion in the RiPoC group, three cycles of ischemia and reperfusion, lasting 5 min each, were performed on one upper limb. Renal function was assessed before surgery, 2 hr after surgery, and at 12-hr intervals for 96 hr postsurgery by measuring serum creatinine (sCr) and the estimated glomerular filtration rate (eGFR). Urine output and urine creatinine were assessed until postoperative day 7, and hospital stay and complication rates were compared.


RESULTS
The time for sCr to reach 50% of its preoperative level was significantly shorter in the RiPoC group than in the control group [12 (12-24) hr for RiPoC vs. 24 (21-36) hr for the control, P=0.005]. The number of patients whose sCr was reduced by 50% within 24 hr was significantly greater in the RiPoC group than in the control group [n=26 (87%) in RiPoC vs. n=18 (60%) in control, P=0.020]. However, there were no differences in sCr and eGFR thereafter, the incidence of graft dysfunction or complication rates between groups.


CONCLUSIONS
In this study, RiPoC appeared to hasten the recovery of graft function within 24 hr but did not affect the graft function thereafter. However, considering most recipients had immediate graft function, further studies with deceased donors or studies powered to detect a smaller difference are needed.
1 Department of Anesthesiology and Pain Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea. 2 Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 3 Department of General Surgery, Division of Transplantation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 4 Address correspondence to: Jong-Hwan Lee, M.D., Ph.D., Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-Dong, Gangnam-Gu, Seoul 135-710 Republic of Korea.
Won Ho
WH
Kim
Jong-Hwan
JH
Lee
Gaab Soo
GS
Kim
Hyun Yee
HY
Sim
Sung Joo
SJ
Kim
D000328:Adult; D015415:Biomarkers / Q000097:blood / Q000652:urine; D003404:Creatinine / Q000097:blood / Q000652:urine; D051799:Delayed Graft Function / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D004311:Double-Blind Method; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D057775:Ischemic Postconditioning / Q000379:methods*; D007668:Kidney / Q000098:blood supply*; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015427:Reperfusion Injury / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
D015415:Biomarkers; D003404:Creatinine