Remote ischemic preconditioning of transplant recipients to reduce graft ischemia and reperfusion injuries: A systematic review.
Farooqui W, Pommergaard HC, et al.Transplantation Reviews 2017; 15: 15.
Aims
To review all available clinical and animal studies to determine whether remote ischemic preconditioning (rIC) of the recipient alone has an effect on ischemia and reperfusion injuries (IRI) in transplant settings.
Interventions
The databased PubMed and EMBASE were searched on April 5, 2016 for prospective, randomized clinical or animal trials written in English that evaluated solid organ transplant recipients (human or animals) who received rIC (versus non-rIC recipients) and experienced graft IRI. Assessment of the abstracts was performed independently and available full-text articles were obtained and evaluated with disagreements between reviewers resolved by consensus.
Participants
12 studies were included in the current systematic review.
Outcomes
Primary outcomes measured included early renal function, recovery of complete renal function, glomerular filtration rate (GFR) and changes in the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2 ratio). Secondary outcomes included need of dialysis, length of admission, kidney injury and inflammatory biomarkers, estimated GFR, mortality, graft survival, and graft rejection.
Follow-up
Variable with most studies reporting a follow-up time < 24h
CET Conclusions
This is a carefully done systematic review of the evidence concerning the effect of remote ischaemic preconditioning in transplant recipients in reducing graft ischaemia and reperfusion injury. An extensive review of the literature retrieved over 3,000 references, which were boiled down to 12 references (seven human and five animal studies) that met the criteria for inclusion. The quality of the evidence of the included trials was in general poor and although remote ischaemic conditioning might be beneficial in transplantation of some organs, this cannot be stated with any clarity from the evidence available. Further clinical studies are required to establish the role, if any, of remote ischaemic conditioning in organ transplantation.
Quality notes
Quality assessment not appropriate
Trial registration
PROSPERO - CRD42016040083