AI Article Synopsis
- The REPAIR RCT investigated whether remote ischaemic preconditioning (RIPC) can enhance kidney function after living-donor kidney transplants, with a focus on glomerular filtration rate (GFR) over a 5-year period.
- The study involved 406 adult donor-recipient pairs across 15 transplant centers, utilizing a double-blind design and randomizing participants to various RIPC methods or control.
- Results showed that early RIPC significantly improved estimated GFR for up to 5 years, with no notable differences in mortality or graft loss between the RIPC and control groups, suggesting RIPC is a safe and effective strategy for enhancing long-term kidney function post-transplant.
Article Abstract
Background: The REnal Protection Against Ischaemia-Reperfusion in transplantation (REPAIR) RCT examined whether remote ischaemic preconditioning (RIPC) improved renal function after living-donor kidney transplantation. The primary endpoint, glomerular filtration rate (GFR), quantified by iohexol at 12 months, suggested that RIPC may confer longer-term benefit. Here, we present yearly follow-up data of estimated GFR for up to 5 yr after transplantation.
Methods: In this double-blind, factorial RCT, we enrolled 406 adult live donor kidney transplant donor-recipient pairs in 15 European transplant centres. RIPC was performed before induction of anaesthesia. RIPC consisted of four 5 min inflations of a BP cuff on the upper arm to 40 mm Hg above systolic BP separated by 5 min periods of cuff deflation. For sham RIPC, cuff inflation to 40 mm Hg was undertaken. Pairs were randomised to sham RIPC, early RIPC only (immediately pre-surgery), late RIPC only (24 h pre-surgery), or dual RIPC (early and late RIPC). The pre-specified secondary outcome of estimated GFR (eGFR) was calculated from serum creatinine measurements, using the Chronic Kidney Disease Epidemiology Collaboration equation. Predefined safety outcomes were mortality and graft loss.
Results: There was a sustained improvement in eGFR after early RIPC, compared with control from 3 months to 5 yr (adjusted mean difference: 4.71 ml min (1.73 m) [95% confidence interval, CI: 1.54-7.89]; P=0.004). Mortality and graft loss were similar between groups (RIPC: 20/205 [9.8%] vs control 24/201 [11.9%]; hazard ratio: 0.79 [95% CI: 0.43-1.43]).
Conclusions: RIPC safely improves long-term kidney function after living-donor renal transplantation when administered before induction of anaesthesia.
Clinical Trial Registration: ISRCTN30083294.
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| http://dx.doi.org/10.1016/j.bja.2019.07.019 | DOI Listing |
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