Francis P Robertson1, Rup Goswami2, Graham P Wright3, Charles Imber2, Dinesh Sharma2, Massimo Malago2, Barry J Fuller4, Brian R Davidson5. 1. Division of Surgery and Intervention Science, Royal Free Campus, University College London, Pond Street, NW3 2QG, UK. Electronic address: francis.robertson.13@ucl.ac.uk. 2. Department of Hepatico Pancreatico Biliary Surgery and Liver Transplantation, Royal Free Hospital Foundation Trust, Pond Street, NW3 2QG, UK. 3. Department of Immunology, Edinburgh Napier University, Craiglockhart Campus, Glenlockhart Road, EH14 1DJ, UK. 4. Division of Surgery and Intervention Science, Royal Free Campus, University College London, Pond Street, NW3 2QG, UK. 5. Division of Surgery and Intervention Science, Royal Free Campus, University College London, Pond Street, NW3 2QG, UK; Department of Hepatico Pancreatico Biliary Surgery and Liver Transplantation, Royal Free Hospital Foundation Trust, Pond Street, NW3 2QG, UK.
Abstract
BACKGROUND: Ischaemia Reperfusion (IR) injury is a major cause of morbidity, mortality and graft loss following Orthotopic Liver Transplantation (OLT). Utilising marginal grafts, which are more susceptible to IR injury, makes this a key research goal. Remote Ischaemic Preconditioning (RIPC) has been shown to ameliorate hepatic IR injury in experimental models. Whether RIPC can reduce IR injury in human liver transplant recipients is unknown. METHODS:Forty patients undergoing liver transplantation were randomized to RIPC or a sham. RIPC was induced through three 5 min cycles of alternate ischaemia and reperfusion of the left leg prior to surgery. Data on clinical outcomes was collected prospectively. Per-operative cytokine levels were measured. RESULTS:Fourty five of 51 patients approached (88%) were willing to enroll in the study. Five patients were excluded and 40 randomized, of which 20 underwent RIPC which was successfully completed in all patients. There were no complications following RIPC. Median day 3 AST levels were slightly higher in the RIPC group (221 IU vs 149 IU, p = 1.00). CONCLUSIONS:RIPC is acceptable and safe in liver transplant recipients. This study has not demonstrated evidence of a reduction in short-term measures of IR injury. Longer follow up will be required and consideration of an altered protocol.
RCT Entities:
BACKGROUND:Ischaemia Reperfusion (IR) injury is a major cause of morbidity, mortality and graft loss following Orthotopic Liver Transplantation (OLT). Utilising marginal grafts, which are more susceptible to IR injury, makes this a key research goal. Remote Ischaemic Preconditioning (RIPC) has been shown to ameliorate hepatic IR injury in experimental models. Whether RIPC can reduce IR injury in human liver transplant recipients is unknown. METHODS: Forty patients undergoing liver transplantation were randomized to RIPC or a sham. RIPC was induced through three 5 min cycles of alternate ischaemia and reperfusion of the left leg prior to surgery. Data on clinical outcomes was collected prospectively. Per-operative cytokine levels were measured. RESULTS: Fourty five of 51 patients approached (88%) were willing to enroll in the study. Five patients were excluded and 40 randomized, of which 20 underwent RIPC which was successfully completed in all patients. There were no complications following RIPC. Median day 3 AST levels were slightly higher in the RIPC group (221 IU vs 149 IU, p = 1.00). CONCLUSIONS:RIPC is acceptable and safe in liver transplant recipients. This study has not demonstrated evidence of a reduction in short-term measures of IR injury. Longer follow up will be required and consideration of an altered protocol.
Authors: Karen L Thomsen; Francis P Robertson; Peter Holland-Fischer; Brian R Davidson; Rajeshwar P Mookerjee; Holger J Møller; Rajiv Jalan; Henning Grønbæk Journal: J Clin Exp Hepatol Date: 2018-10-05
Authors: Zoltan Czigany; Christian Bleilevens; Christian Beckers; Christian Stoppe; Michaela Möhring; Andras Fülöp; Attila Szijarto; Georg Lurje; Ulf P Neumann; René H Tolba Journal: PLoS One Date: 2018-04-04 Impact factor: 3.240
Authors: Aki Uutela; Ilkka Helanterä; Karl Lemström; Arie Passov; Simo Syrjälä; Fredrik Åberg; Heikki Mäkisalo; Arno Nordin; Marko Lempinen; Ville Sallinen Journal: BMJ Open Date: 2020-11-16 Impact factor: 2.692