The influence of warm ischemia elimination on kidney injury during transplantation - clinical and molecular study.
Kaminska D, Koscielska-Kasprzak K, et al.Scientific Reports 2016; 6: 36118.
Aims
To assess the effect of warm ischemia elimination on kidney allograft function, histological changes and immune-related gene expression.
Interventions
Matched pairs of kidneys (two kidneys harvested from the same donor) were transplanted into recipients either by using kidney surface cooling during implantation (ice bag technique, IBT group), versus standard technique (ST group).
Participants
46 kidney allograft recipients (17 females and 29 males aged between 21-71 years) received grafts from 23 deceased donors ( 10 females and 13 males aged between 20-63 years).
Outcomes
The primary outcomes measured were gene expression levels, histological changes, allograft function and detrimental events such as delayed graft function and/or acute rejection.
Follow-up
5 years
CET Conclusions
This small clinical trial used an ice bag to keep the kidney cool during the vascular anastomoses, and thereby reduce warm ischaemic time. It is not clear which outcome the study was powered for. There were no significant differences in clinical outcomes (BPAR, DGF, graft survival. The study did provide evidence of correlation between gene expression and outcome, however. Although in multivariate analysis none of the molecular markers proved to be independent predictors of worse outcome (whereas warm ischaemic time and donor age were). There was no significant difference in the Remuzzi score for protocol biopsies. Kidney pairs were randomised so that one would enter each treatment arm.
Data analysis
Per protocol analysis
Trial registration
ISRCTN - 10879277