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Remote ischaemic preconditioning in orthotopic liver transplantation (RIPCOLT trial): a pilot randomized controlled feasibility study

Robertson, Francis P.; Goswami, Rup; Wright, Graham P.; Imber, Charles; Sharma, Dinesh; Malago, Massimo; Fuller, Barry J.; Davidson, Brian R.

Authors

Francis P. Robertson

Rup Goswami

Charles Imber

Dinesh Sharma

Massimo Malago

Barry J. Fuller

Brian R. Davidson



Abstract

Background
Ischaemia Reperfusion (IR) injury is a major cause of morbidity, mortality and graft loss following Orthotopic Liver Transplantation (OLT). Utilising marginal grafts, which are more susceptible to IR injury, makes this a key research goal. Remote Ischaemic Preconditioning (RIPC) has been shown to ameliorate hepatic IR injury in experimental models. Whether RIPC can reduce IR injury in human liver transplant recipients is unknown.
Methods
Forty patients undergoing liver transplantation were randomized to RIPC or a sham. RIPC was induced through three 5 min cycles of alternate ischaemia and reperfusion of the left leg prior to surgery. Data on clinical outcomes was collected prospectively. Per-operative cytokine levels were measured.
Results
Fourty five of 51 patients approached (88%) were willing to enroll in the study. Five patients were excluded and 40 randomized, of which 20 underwent RIPC which was successfully completed in all patients. There were no complications following RIPC. Median day 3 AST levels were slightly higher in the RIPC group (221 IU vs 149 IU, p = 1.00).
Conclusions
RIPC is acceptable and safe in liver transplant recipients. This study has not demonstrated evidence of a reduction in short-term measures of IR injury. Longer follow up will be required and consideration of an altered protocol.

Citation

Robertson, F. P., Goswami, R., Wright, G. P., Imber, C., Sharma, D., Malago, M., …Davidson, B. R. (2017). Remote ischaemic preconditioning in orthotopic liver transplantation (RIPCOLT trial): a pilot randomized controlled feasibility study. HPB, 19(9), 757-767. https://doi.org/10.1016/j.hpb.2017.05.005

Journal Article Type Article
Acceptance Date May 8, 2017
Online Publication Date Jun 24, 2017
Publication Date 2017-09
Deposit Date Dec 11, 2018
Journal HPB
Print ISSN 1365-182X
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 19
Issue 9
Pages 757-767
DOI https://doi.org/10.1016/j.hpb.2017.05.005
Keywords Hepatology; Gastroenterology
Public URL http://researchrepository.napier.ac.uk/Output/1432675