title: Remote Ischemic Conditioning on Recipients of Deceased Renal Transplants Does Not Improve Early Graft Function: A Multicenter Randomized, Controlled Clinical Trial.
abstract: Delayed graft function is a frequent complication following deceased donor renal transplantation, and is closely related to ischemia-reperfusion injury. Experimental and clinical studies have shown protection by remote ischemic conditioning (RIC). We hypothesized that recipient RIC before kidney graft reperfusion reduces the time to graft recovery. This multicenter, blinded, randomized, controlled clinical trial included 225 adult recipients of renal transplants from deceased donors at four transplantation centers in Denmark, Sweden, and the Netherlands. Participants were randomized 1:1 to RIC or sham-RIC. RIC consisted of 4 × 5-min thigh occlusion by an inflatable tourniquet each followed by 5-min deflation, performed during surgery prior to graft reperfusion. The tourniquet remained deflated for sham-RIC. The primary endpoint was the estimated time to a 50% decrease in baseline plasma creatinine (tCr50) calculated from plasma creatinine measurements 30 days posttransplant or 30 days after the last, posttransplant dialysis. No significant differences were observed between RIC and sham-RIC-treated patients in the primary outcome median tCr50 (122 h [95% confidence interval [CI] 98-151] vs. 112 h [95% CI 91-139], p = 0.58), or the number of patients receiving dialysis in the first posttransplant week (33% vs. 35%, p = 0.71). Recipient RIC does not reduce the time to graft recovery in kidney transplantation from deceased donors. ClinicalTrials.gov: NCT01395719.
authors.affiliation: Department of Renal Medicine, Aarhus University, Aarhus, Denmark.|Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.
authors.forename: N V
authors.initials: NV
authors.lastname: Krogstrup
authors.affiliation: The Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Oltean
authors.affiliation: Department of Anaesthesiology, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: G J
authors.initials: GJ
authors.lastname: Nieuwenhuijs-Moeke
authors.affiliation: Division of HPB & Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
authors.forename: F J M F
authors.initials: FJ
authors.lastname: Dor
authors.affiliation: Department of Urology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: U
authors.initials: U
authors.lastname: Møldrup
authors.affiliation: Department of Pathology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: S P
authors.initials: SP
authors.lastname: Krag
authors.affiliation: Department of Biostatistics, Aarhus University, Aarhus, Denmark.
authors.forename: B M
authors.initials: BM
authors.lastname: Bibby
authors.affiliation: Department of Renal Medicine, Aarhus University, Aarhus, Denmark.|Department of Biomedicine, Aarhus University, Aarhus, Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Birn
authors.affiliation: Department of Renal Medicine, Aarhus University, Aarhus, Denmark.|Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.
authors.forename: B
authors.initials: B
authors.lastname: Jespersen
mesh_terms: D000328:Adult; D000368:Aged; D003643:Death; D051799:Delayed Graft Function / Q000517:prevention & control*; D005260:Female; D006085:Graft Survival; D006801:Humans; D019194:Ischemic Preconditioning / Q000379:methods*; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D015427:Reperfusion Injury / Q000517:prevention & control*; D014019:Tissue Donors
keywords: clinical research/practice; clinical trial; delayed graft function (DGF); ischemia reperfusion injury (IRI); kidney (allograft) function/dysfunction; kidney transplantation/nephrology; organ transplantation in general