Does liver ischemic preconditioning in brain death donors induce kidney preconditioning? a retrospective analysis

Kunj K. Desai, Cesar Mora-Esteves, Bart K. Holland, George Dikdan, Adrian Fisher, Dorian J. Wilson, Baburao Koneru

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

BACKGROUND: It is unclear whether ischemic preconditioning (IPC) of solid organs induces remote IPC (RIPC) in donors after brain death (DBD). METHODS: Outcomes in kidney recipients from 163 DBD in two randomized trials of liver IPC (5 min=62 and 10 min=101) were obtained retrospectively from the Scientific Registry of Transplant Recipients. Controls were kidney recipients from donors without IPC. Mean cold ischemia times were less than 20 hr. Primary outcomes were delayed graft function, defined as dialysis during the first posttransplantation week, and death-censored graft survival. Secondary outcomes were duration of initial hospital stay, patient survival, and estimated glomerular filtration rate 6, 12, 36, and 60 months after transplantation. RESULTS: After exclusions (40 kidneys not recovered, 21 not transplanted, 8 en bloc, 23 with extrarenal organs, and 6 with missing records), 228 recipients were included. Delayed graft function occurred in 23% of No RIPC and 28% of RIPC kidneys (P=0.54). One-and 3-year graft survival rates were 92% and 90%, respectively, in the No RIPC and 90% and 81%, respectively, in the RIPC group (P=0.12), and mean hospital stay was 9.3±13.9 and 9.7±8.2 days, respectively (P=0.15). There were no significant between group differences in patient survival and estimated glomerular filtration rate at any time point. CONCLUSIONS: Despite design and power limitations, our results suggest that liver IPC in DBD is of no clinical benefit to kidney recipients. Inconsistent efficacy and impracticality severely limit the usefulness of IPC in DBD. Other modalities of preconditioning should be tested.

Original languageEnglish (US)
Pages (from-to)337-343
Number of pages7
JournalTransplantation
Volume97
Issue number3
DOIs
StatePublished - Feb 15 2014

All Science Journal Classification (ASJC) codes

  • Transplantation

Keywords

  • Delayed graft function
  • Donors after brain death
  • Ischemic preconditioning
  • Kidney transplantation
  • Remote preconditioning

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