Abbas Ameer Fadhel, Shahbaz Haania, Gumera Armand, Al-Shammari Ali Saad, Alchamaley Mohanad Mahdey Salih, Hashim Hashim Talib, Abdeltawwab Mohannad, Amin Mahmoud
Department of surgery, University of Al-Qadisiyah College of Medicine, Al Diwaniyah.
Dow University of Health Sciences, Karachi, Pakistan.
Ann Med Surg (Lond). 2024 Jul 5;86(9):5455-5460. doi: 10.1097/MS9.0000000000002306. eCollection 2024 Sep.
Remote ischemic preconditioning (RIPC) is a phenomenon in which the induction of shortened periods of ischemia prior to surgical procedures within a distant tissue preserves other tissues or organs of concern, such as the liver or kidney in transplant surgery, in the event of prolonged ischemic insults. The authors aim to evaluate the effectiveness of RIPC in patients undergoing transplant surgery, specifically kidney and liver transplants.
PubMed, Embase, and Scopus were searched until 19 December 2023 for trials evaluating RIPC in patients undergoing transplant surgery. A total of 9364 search articles were obtained, which yielded 10 eligible studies. Data analysis was done using RevMan 5.4 software. The risk of bias was done using Cochrane risk of bias tool.
For graft rejection, the study observed a relative risk of 0.99 (95% CI, 0.49-1.98, =0.97) from 5 trials, indicating no significant effect of RIPC on graft survival in both kidney and liver transplants. The length of hospital stay also showed no significant decrease for those undergoing RIPC, with mean difference (MD) of -0.58 (95% CI, -1.38 to 0.23, =0.16). GFR at 1-year post-kidney transplant did not significantly change in the RIPC group compared to controls, as evidenced by an MD of -0.13 (95% CI, -3.79 to 3.54, =0.95). These results collectively suggest that RIPC may not be effective in reducing patient, or graft, outcomes.
远程缺血预处理（RIPC）是一种现象，即在远处组织进行手术前诱导短暂的缺血期，可在发生长时间缺血损伤时保护其他相关组织或器官，如移植手术中的肝脏或肾脏。作者旨在评估RIPC在接受移植手术患者中的有效性，特别是肾移植和肝移植患者。
检索了截至2023年12月19日的PubMed、Embase和Scopus数据库，以查找评估RIPC在接受移植手术患者中的试验。共获得9364篇检索文章，其中10项符合条件的研究。使用RevMan 5.4软件进行数据分析。使用Cochrane偏倚风险工具评估偏倚风险。
对于移植排斥反应，该研究从5项试验中观察到相对风险为0.99（95%CI，0.49 - 1.98，P = 0.97），表明RIPC对肾移植和肝移植的移植物存活均无显著影响。接受RIPC的患者住院时间也没有显著缩短，平均差值（MD）为 - 0.58（95%CI， - 1.38至0.23，P = 0.16）。肾移植术后1年时，RIPC组的肾小球滤过率（GFR）与对照组相比没有显著变化，平均差值为 - 0.13（95%CI， - 3.79至3.54，P = 0.95）。这些结果共同表明，RIPC可能对改善患者或移植物的预后无效。
