Combined ischaemic conditioning on deceased donor renal transplants
Research type
Research Study
Full title
Combined remote Ischaemic pre- conditioning and ischaemic post conditioning in deceased donor renal transplants
IRAS ID
168483
Contact name
Luxme Nadarajah
Contact email
Sponsor organisation
Queen Mary University
Duration of Study in the UK
2 years, 0 months, 1 days
Research summary
As the prevalence of end stage kidney disease increases, the demand for renal transplants also increases. To meet the high demand for organs the donor pool has expanded with more deceased donor transplants being used. Unfortunately, it is this group of patients that have the worst long term outcomes, partly due to injury that occurs when there is ischaemia (limiting blood supply) followed by reperfusion. This injury occurs when an organ is taken from a donor and implanted into a recipient and is a fundamental part of the kidney transplant process. Unfortunately, this injury leads to delayed graft function which can lead to worse survival outcomes. It is hypothesised that limiting this injury will lead to longer graft survival.
In has been demonstrated that brief episodes of ischaemia to an organ followed by reperfusion could provide profound tissue protection against ischaemia-reperfusion injury. This was termed ischaemic preconditioning (IPC). This concept was extended to show that performing this process remotely (to another organ) could confer tissue protection - ‘remote ischaemic conditioning’ (RIPC). Furthermore, performing ischaemic conditioning after reperfusion could also provide organ protection – ischaemic post conditioning(iPOST).In nephrology animal data to suggests that IPC, RIPC and iPOST can lead to renal protection. We propose to examine the effect of combined ischaemic conditioning on deceased donor kidney recipients.
Our study will be a pilot randomised, prospective, single centre study to determine whether combining iPOST with RIPC will decrease the occurrence of delayed graft function in deceased kidney transplants. Patients will be randomised to either the conditioning or sham group. All patients will receive medical therapy as per local protocol with no changes made to immunosuppressive regimes. Before transplantation the patient will undergo remote ischaemic conditioning, this involves inflating a blood pressure cuff to over 15mmHg above resting blood pressure for 5 minutes followed by 5 minutes of reperfusion for 3 cycles. Ischaemic post conditioning will occur after the transplant surgeon has transplanted the kidney. After the blood vessels are anastomosed the transplant surgeon will occlude the renal artery with their finger for 1 minute and then let reperfusion happen for 1 minute, this will occur 5 times. There will be no other intervention in the study and all data collected will be part of normal clinical practice.REC name
East of England - Cambridgeshire and Hertfordshire Research Ethics Committee
REC reference
15/EE/0485
Date of REC Opinion
15 Jan 2016
REC opinion
Further Information Favourable Opinion