Remote Ischemic Preconditioning Increases Transplantation of Abdominal Organs in Standard Criteria Neurological Death Donors
1Surgery, Rutgers-New Jersey Medical School, Newark, NJ
2Surgery, University of Texas Health Science Center, San Antonio, TX
3Texas Organ Sharing Alliance, San Antonio, TX
4Preventive Medicine, Rutgers-New Jersey Medical School, Newark, NJ.
Meeting: 2015 American Transplant Congress
Abstract number: 15
Keywords: Brain death, Ischemia, Multicenter studies, Procurement
Session Information
Session Name: Concurrent Session: Deceased Donor Management
Session Type: Concurrent Session
Date: Sunday, May 3, 2015
Session Time: 2:15pm-3:45pm
Presentation Time: 2:39pm-2:51pm
Location: Room 119-A
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.
SCD | Abdominal Recovered | Abdominal Transplanted | Thoracic Recovered | Thoracic Transplanted | |
RIPC | 133 | 389 | 360 | 125 | 122 |
No RIPC | 131 | 380 | 331 | 149 | 145 |
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.
To cite this abstract in AMA style:
Bongu A, Washburn W, Oliver J, Nespral J, Davidow A, Kadric C, Dikdan G, Lewis J, Pandit U, Beidas A-K, Tourtellot C, Brown L, Koneru B. Remote Ischemic Preconditioning Increases Transplantation of Abdominal Organs in Standard Criteria Neurological Death Donors [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/remote-ischemic-preconditioning-increases-transplantation-of-abdominal-organs-in-standard-criteria-neurological-death-donors/. Accessed November 4, 2024.« Back to 2015 American Transplant Congress