Organoprotective Effect of Remote Ischemic Preconditioning during Living Donor Liver Transplantation, A Prospective Randomized Double-Blinded Study

Abstract

Background: Ischemia reperfusion injury (IRI) during liver transplantation carries a substantial risk for graft damage, and other major organ injury. Strategies to minimize IRI in the grafted liver are of paramount importance. Remote ischemic preconditioning (RIP) is a recently described technique that can offer a liver protective effect against IRI. Patients and Methods: In this prospective randomized study, consent was obtained from 80 couples (donor– recipient) prepared for liver transplantation (LT). Patients were divided randomly (using closed envelope technique) into two groups: RIP group (n=35) as RIP procedure was run in the donor non-dominant hand just at the start of parenchymal transection and control group (n= 35). In all the study cases, the pressure cuff was wrapped around the recipient arm. In RIP group, four sets of 5 minutes manual pressure cuff elevation to 200 mmHg, separated by 5 minutes of release (Using the non-dominant hand). Results: No statistically significant difference was found between the biochemical profile (SGPT, CRP, and bilirubin) of the recipients in both of the study groups. Similarly, post-operative kidney function (Serum creatinine) was comparable findings in the two studied groups. Conclusion: RIP in living donor liver transplantation failed to show a protective effect neither on the graft response to reperfusion injury, nor the on the postoperative kidney functions. Future studies are recommended taking into consideration histopathological, tissue damage scores.