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|Title:||Safety, feasibility, and effect of remote ischemic conditioning in patients undergoing lung transplantation.|
Snell, Gregory I
Levvey, Bronwyn J
Sharland, Alexandra F
|ANZCA/FPM Author:||Lin, E|
|Citation:||The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 2014-11; 33(11): 1139-48|
|Abstract:||Primary graft dysfunction (PGD) remains a significant problem after lung transplantation. Data from animal and clinical studies suggest that remote ischemic conditioning (RIC) may reduce ischemia-reperfusion injury in solid organ transplantation. A pilot randomized controlled trial of 60 patients undergoing bilateral sequential lung transplantation assessed the utility of RIC in attenuating PGD. Treated recipients underwent 3 cycles of lower limb ischemic conditioning before allograft reperfusion. The primary outcome measure was a comparison of the partial pressure of arterial oxygen/fraction of inspired oxygen ratio (P/F ratio) between treatment groups. No adverse effects of tourniquet application were observed. The mean lowest P/F ratio during the first 24 hours after transplantation was 271.3 mm Hg in the treatment arm vs 256.1 mm Hg in the control arm (p = 0.46). PGD grade and severity and the rate of acute rejection also showed a tendency to favor the treatment arm. Sub-group analysis demonstrated a significant benefit of treatment in patients with a primary diagnosis of restrictive lung disease, a group at high risk for the development of PGD. RIC was not accompanied by systemic release of high-molecular-weight group box 1. Levels of cytokines, high-molecular-weight group box 1, and endogenous secretory receptor for advanced glycation end products peaked within 2 hours after reperfusion and likely reflected donor organ quality rather than an effect of RIC. RIC did not significantly improve P/F ratios or PGD in this randomized controlled trial. However, encouraging results in this small study warrant a large multicenter trial of RIC in lung transplantation.|
|Journal Title:||The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation|
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
|Appears in Collections:||Scholarly and Clinical|
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