title: Limited Clinical Utility of Remote Ischemic Conditioning in Renal Transplantation: A Meta-Analysis of Randomized Controlled Trials.
abstract: OBJECTIVE
  We conducted this meta-analysis of randomized controlled trials (RCTs) to investigate whether remote ischemic conditioning (RIC) could improve graft functions in kidney transplantation.
  
  
  METHODS
  PubMed, Web of Science, and Cochrane Library were comprehensively searched to identify all eligible studies by October 5, 2016. The treatment effects were examined with risk ratio (RR) and weighted mean difference with the corresponding 95% confidence intervals (CI). The statistical significance and heterogeneity were assessed with both Z-test and Q-test.
  
  
  RESULTS
  A total of six RCTs including 651 recipients, were eventually identified. Compared to the controls, RIC could reduce the incidence of delayed graft function (DGF) after kidney transplantation (random-effects model: RR = 0.89; fixed-effect model: RR = 0.84). However, the decrease did not reveal statistical significance. The subgroup analysis by RIC type demonstrated no significant difference among the three interventions in protecting renal allografts against DGF. Furthermore, no significant difference could be observed in the incidence of acute rejection, graft loss, 50% fall in serum creatinine, as well as the estimated glomerular filtration rate and hospital stay between the RIC and Control groups.
  
  
  CONCLUSIONS
  This meta-analysis suggested that RIC might exert renoprotective functions in human kidney transplantation, and further well-designed RCTs with large sample size are warranted to assess its clinical efficacy.
authors.affiliation: Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.|Department of Urology, Nanjing First Hospital, Nanjing Medical University,Nanjing, Jiangsu, China.
authors.forename: Chang-Cheng
authors.initials: CC
authors.lastname: Zhou
authors.affiliation: Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.|Department of Urology, Nanjing First Hospital, Nanjing Medical University,Nanjing, Jiangsu, China.
authors.forename: Yu-Zheng
authors.initials: YZ
authors.lastname: Ge
authors.affiliation: Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.|Department of Urology, Nanjing First Hospital, Nanjing Medical University,Nanjing, Jiangsu, China.
authors.forename: Wen-Tao
authors.initials: WT
authors.lastname: Yao
authors.affiliation: Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.|Department of Urology, Nanjing First Hospital, Nanjing Medical University,Nanjing, Jiangsu, China.
authors.forename: Ran
authors.initials: R
authors.lastname: Wu
authors.affiliation: Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.|Department of Urology, Nanjing First Hospital, Nanjing Medical University,Nanjing, Jiangsu, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Xin
authors.affiliation: Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.|Department of Urology, Nanjing First Hospital, Nanjing Medical University,Nanjing, Jiangsu, China.
authors.forename: Tian-Ze
authors.initials: TZ
authors.lastname: Lu
authors.affiliation: Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.|Department of Urology, Nanjing First Hospital, Nanjing Medical University,Nanjing, Jiangsu, China.
authors.forename: Ming-Hao
authors.initials: MH
authors.lastname: Li
authors.affiliation: Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.|Department of Urology, Nanjing First Hospital, Nanjing Medical University,Nanjing, Jiangsu, China.
authors.forename: Kai-Wei
authors.initials: KW
authors.lastname: Song
authors.affiliation: Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.|Department of Urology, Nanjing First Hospital, Nanjing Medical University,Nanjing, Jiangsu, China.
authors.forename: Min
authors.initials: M
authors.lastname: Wang
authors.affiliation: Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.|Department of Urology, Nanjing First Hospital, Nanjing Medical University,Nanjing, Jiangsu, China.
authors.forename: Yun-Peng
authors.initials: YP
authors.lastname: Zhu
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China.
authors.forename: Meng
authors.initials: M
authors.lastname: Zhu
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China.
authors.forename: Li-Guo
authors.initials: LG
authors.lastname: Geng
authors.affiliation: Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
authors.forename: Xiao-Fei
authors.initials: XF
authors.lastname: Gao
authors.affiliation: Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.|Department of Urology, Nanjing First Hospital, Nanjing Medical University,Nanjing, Jiangsu, China.
authors.forename: Liu-Hua
authors.initials: LH
authors.lastname: Zhou
authors.affiliation: Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.|Department of Urology, Nanjing First Hospital, Nanjing Medical University,Nanjing, Jiangsu, China.
authors.forename: Sheng-Li
authors.initials: SL
authors.lastname: Zhang
authors.affiliation: Department of Urology, Nanjing First Hospital, Nanjing Medical University,Nanjing, Jiangsu, China.
authors.forename: Jia-Geng
authors.initials: JG
authors.lastname: Zhu
authors.affiliation: Center for Renal Transplantation, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.|Department of Urology, Nanjing First Hospital, Nanjing Medical University,Nanjing, Jiangsu, China.
authors.forename: Rui-Peng
authors.initials: RP
authors.lastname: Jia
mesh_terms: D006084:Graft Rejection / Q000503:physiopathology; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007165:Immunosuppression Therapy; D019194:Ischemic Preconditioning / Q000379:methods*; D007668:Kidney / Q000293:injuries / Q000503:physiopathology; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D016032:Randomized Controlled Trials as Topic; D015427:Reperfusion Injury / Q000503:physiopathology / Q000628:therapy