The ischemic preconditioning paradox in deceased donor liver transplantation - Evidence from a prospective randomized single blind clinical trial

B. Koneru, A. Shareef, G. Dikdan, K. Desai, K. M. Klein, B. Peng, R. H. Wachsberg, A. N. De La Torre, M. Debroy, A. Fisher, D. J. Wilson, A. K. Samanta

Research output: Contribution to journalArticlepeer-review

66 Scopus citations

Abstract

While animal studies show that ischemic preconditioning (IPC) is beneficial in liver transplantation (LT), evidence from few smaller clinical trials is conflicting. From October 2003 to July 2006, 101 deceased donors (DD) were randomized to 10 min IPC (n = 50) or No IPC (n = 51). Primary objective was efficacy of IPC to decrease reperfusion (RP) injury. Both groups had similar donor risk index (DRI) (1.54 vs. 1.57). Aminotransferases on days 1 and 2 were significantly greater (p < 0.05) in IPC recipients. In multivariate analyses, IPC had an independent effect only on day 2 aspartate transferase. Prothrombin time, bilirubin and histological injury were similar in both groups. IPC had no significant effect on plasma TNF-α, IL-6 and IL-10 in the donor and TNF-α and IL-6 in the recipient. In contrast, IPC recipients had a significant rise in systemic IL-10 levels after RP (p < 0.05) and had fewer moderate/severe rejections within 30 days (p = 0.09). Hospital stay was similar in both groups. One-year patient and graft survival in IPC versus No IPC were 88% versus 78% (p = 0.1) and 86 versus 76% (p = 0.25), respectively. IPC increases RP injury after DDLT, an 'IPC paradox'. Other potential benefits of IPC are limited. IPC may be more effective in combination with other preconditioning regimens.

Original languageEnglish (US)
Pages (from-to)2788-2796
Number of pages9
JournalAmerican Journal of Transplantation
Volume7
Issue number12
DOIs
StatePublished - Dec 2007

Keywords

  • Deceased donor
  • Ischemia/reperfusion injury
  • Ischemic preconditioning
  • Liver transplantation

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

Fingerprint Dive into the research topics of 'The ischemic preconditioning paradox in deceased donor liver transplantation - Evidence from a prospective randomized single blind clinical trial'. Together they form a unique fingerprint.

Cite this