NIV Congres

Objective Ischemic postconditioning (IPoC) may reduce renal ischemia-reperfusion injury (IRI) after kidney transplantation. We performed a first human pilot trial to study the feasibility and safety of IPoC in human deceased-after-cardiac death (DCD) kidney transplantation (KT).

Methods All patients undergoing DCD KT were eligible. The IPoC algorithm consisted of 1 minute reperfusion followed by 1 minute of ischemia, repeated three times. All complications of this procedure were listed. The primary outcome was the incidence of delayed graft function (DGF). Secondary outcome was renal function at 12 weeks. Data were compared to a historical control group (n=40), consisting of our most recent cohort of DCD KT patients before trial initiation. Follow up was 12 weeks.

Results A total of n=20 patients was included. Mean donor age and serum creatinine were higher in the experimental than in the historical control group: 61 yr (20-71) versus 51.5 yr (24-74) (p=0.01) and 79 umol/L ± 34.2 versus 63.8 umol/L ± 23.4 (p=0.047), respectively. In the experimental group, more kidneys had massive atherosclerosis: 25% vs 2.5% (p=0.01). IPoC was successfully applied in all patients. One patient suffered from a venous tear due to clamp manipulation. The incidence of DGF was 85% vs 62.5% (p= 0.07). Renal function was comparable between groups at 12 weeks after transplantation: 161 umol/L (109-536) vs 149 umol/L (81-315) (p=0.10). Postoperatively, no additional risks or complications were seen as a consequence of IPoC.

Conclusion We demonstrate for the first time that IPoC is feasible and appears to be safe in human KT. No benefit in terms of reduced DGF or better renal function was observed as a result of IPoC. This may have been caused by poorer donor organ quality.