• Kristin V Veighey, Jennifer M Nicholas, Tim Clayton, Rosemary Knight, Steven Robertson, Neil Dalton, Mark Harber, Watson Christopher J E CJE Department of Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK., Johan W De Fijter, Stavros Loukogeorgakis, and Raymond MacAllister.
• Wessex Kidney Centre, Portsmouth Hospitals NHS Trust, Portsmouth, Hampshire, UK; Research and Development, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK. Electronic address: kristin.veighey@uhs.nhs.uk.
• Br J Anaesth. 2019 Nov 1; 123 (5): 584-591.

BackgroundThe REnal Protection Against Ischaemia-Reperfusion in transplantation (REPAIR) RCT examined whether remote ischaemic preconditioning (RIPC) improved renal function after living-donor kidney transplantation. The primary endpoint, glomerular filtration rate (GFR), quantified by iohexol at 12 months, suggested that RIPC may confer longer-term benefit. Here, we present yearly follow-up data of estimated GFR for up to 5 yr after transplantation.MethodsIn this double-blind, factorial RCT, we enrolled 406 adult live donor kidney transplant donor-recipient pairs in 15 European transplant centres. RIPC was performed before induction of anaesthesia. RIPC consisted of four 5 min inflations of a BP cuff on the upper arm to 40 mm Hg above systolic BP separated by 5 min periods of cuff deflation. For sham RIPC, cuff inflation to 40 mm Hg was undertaken. Pairs were randomised to sham RIPC, early RIPC only (immediately pre-surgery), late RIPC only (24 h pre-surgery), or dual RIPC (early and late RIPC). The pre-specified secondary outcome of estimated GFR (eGFR) was calculated from serum creatinine measurements, using the Chronic Kidney Disease Epidemiology Collaboration equation. Predefined safety outcomes were mortality and graft loss.ResultsThere was a sustained improvement in eGFR after early RIPC, compared with control from 3 months to 5 yr (adjusted mean difference: 4.71 ml min-1 (1.73 m)-2 [95% confidence interval, CI: 1.54-7.89]; P=0.004). Mortality and graft loss were similar between groups (RIPC: 20/205 [9.8%] vs control 24/201 [11.9%]; hazard ratio: 0.79 [95% CI: 0.43-1.43]).ConclusionsRIPC safely improves long-term kidney function after living-donor renal transplantation when administered before induction of anaesthesia.Clinical Trial RegistrationISRCTN30083294.Copyright © 2019 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

30 keywords...

hide…