Ischemic postconditioning (IPoC) may reduce renal ischemia-reperfusion injury (IRI) after kidney transplantation (KT). We performed a first human pilot trial to study the feasibility and safety of IPoC in human deceased-after-cardiac death (DCD) KT.
All patients undergoing DCD KT were eligible. The IPoC algorithm consisted of 1 minute reperfusion followed by 1 minute of ischemia, repeated three times. All complications of this procedure were listed. The primary outcome was the incidence of delayed graft function (DGF). Secondary outcome was renal function at 12 weeks. Data were compared to a historical control group (n=40), consisting of our most recent cohort of DCD KT patients before trial initiation. Follow-up was 12 weeks.
A total of n=20 patients was included. Data are expressed as the experimental group (IPoC) vs historical controls. Mean donor age and serum creatinine were higher in the experimental group: 61 yr (20-71) versus 51.5 yr (24-74) (p< 0.05) and 79 umol/L ± 34.2 versus 63.8 umol/L ± 23.4 (p<0.05), respectively. In the experimental group, more kidneys had massive atherosclerosis: 25% vs 2.5% (p<0.05). IPoC was successfully applied in all patients. In one patient a renal vein laceration occurred during IPoC due to clamp manipulation, which could be repaired immediately. The incidence of DGF was 85% vs 62.5% (not significant). Renal function was comparable between groups at 12 weeks after transplantation: 161 umol/L (109-536) vs.149 umol/L (81-315) (not significant). Postoperative, no additional risks or complications were seen as a consequence of IPoC.
We demonstrate for the first time that IPoC is feasible and appears to be safe in human KT. No benefit in terms of reduced DGF or better renal function was observed as a result of IPoC. However, donor organ quality was clearly worse in the experimental group. The fact that similar results were obtained, despite this significant difference in graft quality, is an observation that merits further research of the potential of IPoC in KT.
To cite this abstract in AMA style:Akker Evanden, Hesselink D, Manintveld O, Lafranca J, Weimar W, IJzermans J, Dor F. First in Human Trial of Ischemic Postconditioning in Kidney Transplantation from Donations after Cardiac Death [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/first-in-human-trial-of-ischemic-postconditioning-in-kidney-transplantation-from-donations-after-cardiac-death/. Accessed October 28, 2020.
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