Limited Clinical Utility of Remote Ischemic Conditioning in Renal Transplantation: A Meta-Analysis of Randomized Controlled Trials.
Zhou C, Ge Y, et al.PLoS ONE 2017; 12(1): e0170729.
Aims
To conduct a meta-analysis to evaluate the therapeutic efficacy and safety of remote ischemic conditioning (RIC) in renal transplantation.
Interventions
The databases PubMed, Web of Science, and Cochrane Library were searched up until October 5, 2016 and the reference lists of reviews and retrieved articles were manually screened. Randomised controlled trials (RCTs) in any language were included where renal transplant recipients were administrated with one type of RIC. Two authors independently assessed studies for inclusion and two investigators independently extracted data from eligible studies using a predesigned data-collection form.
Participants
6 RCTs were included in the meta-analysis with a total of 651 renal transplant recipients.
Outcomes
The primary outcome measured was the incidence of delayed graft function. Secondary outcomes included acute rejection, graft loss, 50% fall in serum creatinine, estimated glomerular filtration rate and hospital stay.
Follow-up
Ranged between 3 - 12 months
CET Conclusions
This meta-analysis investigates the role of remote ischaemic preconditioning on outcomes following renal transplantation. The authors identify six randomised controlled trials, and meta-analysis demonstrates no significant difference in outcomes in terms of DGF, acute rejection, graft function or graft survival. The authors conclude that RIC may exert a renoprotective effect, a conclusion that is not supported by the presented data. The confidence intervals presented are quite wide, and included studies small, meaning that no firm conclusions can be drawn from the existing data in this area. The searches, screening and data extraction are performed in a robust manner, although there is no attempt to identify unpublished literature and conference abstracts are excluded raising the risk of publication bias. The authors attempt subgroup analysis by conditioning method, which is probably unwise given the small number of studies (1-3 in each subgroup).
Quality notes
Quality assessment not appropriate
Trial registration
None