title: Protocol for a prospective randomized controlled trial of recipient remote ischaemic preconditioning in orthotopic liver transplantation (RIPCOLT trial).
abstract: Ischaemic reperfusion (IR) injury is a major cause of graft loss, morbidity and mortality following orthotopic liver transplantation (OLT). Demand for liver transplantation has resulted in increasing use of marginal grafts that are more prone to IR injury. Remote ischaemic preconditioning (RIPC) reduces IR injury in experimental models, but recipient RIPC has not been evaluated clinically.
  
  
  METHODS
  A single-centre double-blind randomized controlled trial (RCT) is planned to test the hypothesis that recipient RIPC will reduce IR injury. RIPC will be performed following recipient anaesthetic induction but prior to skin incision. The protocol involves 3 cycles of 5 min of lower limb occlusion with a pneumatic tourniquet inflated to 200 mmHg alternating with 5 min of reperfusion. In the control group, the sham will involve the cuff being placed on the thigh but without being inflated. The primary endpoint is ability to recruit patients to the trial and safety of RIPC. The key secondary endpoint is a reduction in serum aspartate transferase levels on the third post-operative day.
  
  
  CONCLUSIONS
  RIPC is a promising strategy to reduce IR injury in liver transplant recipients as there is a clear experimental basis, and the intervention is both inexpensive and easy to perform. This is the first trial to investigate RIPC in liver transplant recipients.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT00796588.
authors.affiliation: Department of Surgery and Interventional Science, Royal Free Campus, Royal Free Hospital, University College London, 9th Floor, Pond Street, London, NW3 2QG UK.
authors.forename: Francis P
authors.initials: FP
authors.lastname: Robertson
authors.affiliation: Department of Surgery and Interventional Science, Royal Free Campus, Royal Free Hospital, University College London, 9th Floor, Pond Street, London, NW3 2QG UK.
authors.forename: Rup
authors.initials: R
authors.lastname: Goswami
authors.affiliation: Department of Immunology, Napier University, Edinburgh, UK.
authors.forename: Graham P
authors.initials: GP
authors.lastname: Wright
authors.affiliation: Department of Surgery and Interventional Science, Royal Free Campus, Royal Free Hospital, University College London, 9th Floor, Pond Street, London, NW3 2QG UK.
authors.forename: Barry
authors.initials: B
authors.lastname: Fuller
authors.affiliation: Department of Surgery and Interventional Science, Royal Free Campus, Royal Free Hospital, University College London, 9th Floor, Pond Street, London, NW3 2QG UK ; HPB and Liver Transplant Unit, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG UK.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Davidson
keywords: Aspartate transferase; Ischaemia reperfusion injury; Liver transplantation; Outcome; Remote ischaemic preconditioning