Background: Remote ischemic preconditioning (RIPC) induces innate protective mechanisms in remote organs. We hypothesized RIPC soon after neurological death (ND) would improve donor organ function and increase organs recovered and transplanted.

Methods: After ND pronouncement and consent, donors were enrolled in a multicenter trial, stratified into standard and extended criteria (SCD/ECD) and randomized (1:1) to RIPC or standard of care. RIPC consisted of 4 cycles of mid thigh cuff inflation/deflation (5 minutes each) performed soon after ND and again at start of organ recovery. Recovery and organ allocation were per practice standards. Outcomes in intent-to-treat analyses included: 1) Changes in creatinine clearance (mL/min) and serum lactate (mg/dL) from baseline to terminal (δCrCl and δlactate), 2) abdominal and thoracic organs recovered and transplanted.

Results: From 7/1/2011 to 6/30/2014, 321 donors were enrolled (264 SCD, 57 ECD). RIPC had no adverse effects. In SCD, the interval from randomization to cross clamp (Int-XC) was 18.9±5.7 in RIPC vs. 19.3±6.7 hours in No RIPC (p=0.9). Median δCrCl was 1.3 (-12.8, 15.8) vs. 0.0 (-9.3, 10.7) mL/min [p=0.4] and δlactate was 0.18 (-0.4, 0.6) vs. 0.09 (-0.4, 0.7) mg/dL [p=0.9] in RIPC and No RIPC, respectively.

In univariate analyses, RIPC increased the odds of transplantation of >2 abdominal organs in SCD by 68% (p<0.05). In multivariate modeling, controlling for donor age, sex, body mass index, and int-XC, RIPC increased odds of transplantation of >2 abdominal organs among subjects with int-XC ≤ 16 hours (OR 4.2, p<0.01). Each 5 year increase in donor age was associated with a 30% decrease in the odds of abdominal organ transplantation. In multivariate analyses of 0 vs. >1and 1 vs. >1 thoracic organs transplanted RIPC had no significant impact.

Conclusions: 1) RIPC is safe and easy to apply in ND donors, 2) RIPC increases the number of abdominal organs transplanted in SCD.

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