The method of distant preconditioning and results of its application in renal transplantation from the living family donor

Keywords: renal ischemia, renal transplantation, іschemic-reperfusion affection, distant ischemic preconditioning


Objective. Elaboration of method for the intraoperative ischemic-reperfusion trauma softening - distant ischemic preconditioning and investigation of results of its introduction into clinical practice.

Materials and methods. The method of distant ischemic preconditioning elaborated have included four procedures the air inflation into the flap for the arterial pressure measuring by 40 mm Hg over the level of systolic arterial pressure, 5 min of duration in every one, with consequent 5-minute intervals for the air release from the flap. The procedure of a distant ischemic preconditioning was conducted after introduction into narcosis, but before the donor's nephrectomy in 30 patients (the main group). The procedure was not conducted in 30 such patients.

Results. The procedure elaborated permits to enhance the glomerular filtration significantly in 6 and 12 mo, to reduce the rate of partial delay of the transplant functioning, its acute rejection and primary dysfunction.

Conclusion. The procedure of a distant ischemic preconditioning elaborated improves the transplanted kidney function.

Author Biographies

M. І. Kyrychenko, Shupyk National Healthcare University of Ukraine, Kyiv

Kyrychenko Maryna Ihorivna, MD, Postgraduate student, Anaesthesiologist
Department of Paediatric Anaesthesiology and Intensive Care,
Shupyk National Healthcare University of Ukraine,
9 Dorogozhytska Str. Kyiv 04112,
+38(044) 205–49–46,
Department of General and Transplant Anesthesiology
Shalimov National Institute of Surgery and Transplantology
30 Heroiv Sevaspolia str., 03126 Kyiv, Ukraine

A. V. Bilyayev, Shupyk National Healthcare University of Ukraine, Kyiv

Biliaiev Andrii Viktorovych – MD, DSci(Med), Professor,
Head of the Department of Paediatric Anaesthesiology and Intensive Care,
Shupyk National Healthcare University of Ukraine,
9 Dorogozhytska Str. Kyiv 04112,
+38(044) 205–49–46, +38(044)205–48–27.

N. G. Davydenko, Shalimov National Institute of Surgery and Transplantology, Kyiv

Davidenko Nina Grigorivna – MD, Anaesthesiologist,
Department of General and Transplant Anesthesiology,
Shalimov National Institute of Surgery and Transplantology
30 Heroiv Sevaspolia str., 03126 Kyiv, Ukraine

A. O. Bychkova, Shalimov National Institute of Surgery and Transplantology, Kyiv

Bychkova Arina Olehivna – Anesthesiologist, resident,
Department of General and Transplant Anesthesiology
Shalimov National Institute of Surgery and Transplantology
30 Heroiv Sevaspolia str., 03126 Kyiv, Ukraine

O. V. Storozhuk, Bogomolets National Medical University, Kyiv

Storozhuk Oryna Volodymirivna – Anesthesiologist, resident,
Department of Anaesthesiology and Intensive Care,
Bogomolets National Medical University
13 T. Shevchenko blvd., Kyiv, 01601
+8 044 234–40–62.


Cheungpasitporn W, Khoury NJ, Thongprayoon C, Craici IM. Is Remote Ischemic Conditioning of Benefit to Patients Undergoing Kidney Transplantation? J Invest Surg. 2019 Jan;32(1):72-4. doi: 10.1080/08941939.2017.1380090. Epub 2017 Oct 12. PMID: 29023177.

Wu J, Feng X, Huang H, Shou Z, Zhang X, Wang R, et al. Remote ischemic conditioning enhanced the early recovery of renal function in recipients after kidney transplantation: a randomized controlled trial. J Surg Res. 2014 May 1;188(1):303-8. doi: 10.1016/j.jss.2013.06.058. Epub 2013 Jul 22. PMID: 24556231.

Veighey KV, Nicholas JM, Clayton T, Knight R, Robertson S, Dalton N, et al. Early remote ischaemic preconditioning leads to sustained improvement in allograft function after live donor kidney transplantation: long-term outcomes in the REnal Protection Against Ischaemia-Reperfusion in transplantation (REPAIR) randomised trial. Br J Anaesth. 2019 Nov;123(5):584-91. doi: 10.1016/j.bja.2019.07.019. Epub 2019 Sep 11. PMID: 31521337.

Mohnen SM, van Oosten MJM, Los J, Leegte MJH, Jager KJ, Hemmelder MH, et al. Healthcare costs of patients on different renal replacement modalities - Analysis of Dutch health insurance claims data. PLoS One. 2019 Aug 15;14(8):e0220800. doi: 10.1371/journal.pone.0220800. PMID: 31415578; PMCID: PMC6695145.

Perović S, Janković S. Renal transplantation vs hemodialysis: cost-effectiveness analysis. Vojnosanit Pregl. 2009 Aug;66(8):639-44. doi: 10.2298/vsp0908639p. PMID: 19780419.

Arze Aimaretti L, Arze S. Preemptive Renal Transplantation-The Best Treatment Option for Terminal Chronic Renal Failure. Transplant Proc. 2016 Mar;48(2):609-11. doi: 10.1016/j.transproceed.2016.02.047. PMID: 27110013.

MacAllister R, Clayton T, Knight R, Robertson S, Nicholas J, Motwani M, et al. REmote preconditioning for Protection Against Ischaemia-Reperfusion in renal transplantation (REPAIR): a multicentre, multinational, double-blind, factorial designed randomised controlled trial. Southampton (UK): NIHR Journals Library; 2015 May. PMID: 26020087.

Krogstrup NV, Oltean M, Bibby BM, Nieuwenhuijs-Moeke GJ, Dor FJ, et al. Remote ischaemic conditioning on recipients of deceased renal transplants, effect on immediate and extended kidney graft function: a multicentre, randomised controlled trial protocol (CONTEXT). BMJ Open. 2015 Aug 20;5(8):e007941. doi: 10.1136/bmjopen-2015-007941. PMID: 26297360; PMCID: PMC4550713.

Zhou CC, Ge YZ, Yao WT, Wu R, Xin H, Lu TZ, et al. Correction: Limited Clinical Utility of Remote Ischemic Conditioning in Renal Transplantation: A Meta-Analysis of Randomized Controlled Trials. PLoS One. 2018 Sep 14;13(9):e0204184. doi: 10.1371/journal.pone.0204184. Erratum for: PLoS One. 2017 Jan 27;12(1):e0170729. PMID: 30216391; PMCID: PMC6138457.

Fernández AR, Sánchez-Tarjuelo R, Cravedi P, Ochando J, López-Hoyos M. Review: Ischemia Reperfusion Injury-A Translational Perspective in Organ Transplantation. Int J Mol Sci. 2020 Nov 13;21(22):8549. doi: 10.3390/ijms21228549. PMID: 33202744; PMCID: PMC7696417.

Zhao H, Alam A, Soo AP, George AJT, Ma D. Ischemia-Reperfusion Injury Reduces Long Term Renal Graft Survival: Mechanism and Beyond. EBioMedicine. 2018 Feb;28:31-42. doi: 10.1016/j.ebiom.2018.01.025. Epub 2018 Feb 2. PMID: 29398595; PMCID: PMC5835570.

Pöge U, Gerhardt T, Stoffel-Wagner B, Palmedo H, Klehr HU, Sauerbruch T, et al. Prediction of glomerular filtration rate in renal transplant recipients: cystatin C or modification of diet in renal disease equation? Clin Transplant. 2006 Mar-Apr;20(2):200-5. doi: 10.1111/j.1399-0012.2005.00466.x. PMID: 16640527.

Savaj S, Shoushtarizadeh T, Abbasi MA, Razavimanesh SH, Ghods AJ. Estimation of glomerular filtration rate with creatinine-based versus cystatin C-based equations in kidney transplant recipients. Iran J Kidney Dis. 2009 Oct;3(4):234-8. PMID: 19841528.

Mannon RB. Delayed Graft Function: The AKI of Kidney Transplantation. Nephron. 2018;140(2):94-8. doi: 10.1159/000491558. Epub 2018 Jul 13. PMID: 30007955; PMCID: PMC6165700.

Murry CE, Jennings RB, Reimer KA. Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. Circulation. 1986 Nov;74(5):1124-36. doi: 10.1161/01.cir.74.5.1124. PMID: 3769170.

Nicholson ML, Pattenden CJ, Barlow AD, Hunter JP, Lee G, Hosgood SA. A Double Blind Randomized Clinical Trial of Remote Ischemic Conditioning in Live Donor Renal Transplantation. Medicine (Baltimore). 2015 Aug;94(31):e1316. doi: 10.1097/MD.0000000000001316. PMID: 26252316; PMCID: PMC4616604.

Krogstrup NV, Oltean M, Nieuwenhuijs-Moeke GJ, Dor FJ, Møldrup U, Krag SP, et al. Remote Ischemic Conditioning on Recipients of Deceased Renal Transplants Does Not Improve Early Graft Function: A Multicenter Randomized, Controlled Clinical Trial. Am J Transplant. 2017 Apr;17(4):1042-9. doi: 10.1111/ajt.14075. Epub 2016 Nov 9. PMID: 27696662.

Thornton J, Striplin S, Liu GS, Swafford A, Stanley AW, Van Winkle DM, et al. Inhibition of protein synthesis does not block myocardial protection afforded by preconditioning. Am J Physiol. 1990 Dec;259(6 Pt 2):H1822-5. doi: 10.1152/ajpheart.1990.259.6.H1822. PMID: 2260706.

McCafferty K, Forbes S, Thiemermann C, Yaqoob MM. The challenge of translating ischemic conditioning from animal models to humans: the role of comorbidities. Dis Model Mech. 2014 Dec;7(12):1321-33. doi: 10.1242/dmm.016741. PMID: 25481012; PMCID: PMC4257001.

Yellon DM, Alkhulaifi AM, Browne EE, Pugsley WB. Ischaemic preconditioning limits infarct size in the rat heart. Cardiovasc Res. 1992 Oct;26(10):983-7. doi: 10.1093/cvr/26.10.983. PMID: 1486593.

Burns PG, Krunkenkamp IB, Calderone CA, Kirvaitis RJ, Gaudette GR, Levitsky S. Is the preconditioning response conserved in senescent myocardium? Ann Thorac Surg. 1996 Mar;61(3):925-9. doi: 10.1016/0003-4975(95)01188-9. PMID: 8619719.

Sumeray MS, Yellon DM. Ischaemic preconditioning reduces infarct size following global ischaemia in the murine myocardium. Basic Res Cardiol. 1998 Oct;93(5):384-90. doi: 10.1007/s003950050106. PMID: 9833150.

Xi L, Hess ML, Kukreja RC. Ischemic preconditioning in isolated perfused mouse heart: reduction in infarct size without improvement of post-ischemic ventricular function. Mol Cell Biochem. 1998 Sep;186(1-2):69-77. PMID: 9774187.

Li G, Chen S, Lu E, Hu T. Protective effects of ischemic preconditioning on lung ischemia reperfusion injury: an in-vivo rabbit study. Thorac Cardiovasc Surg. 1999 Feb;47(1):38-41. doi: 10.1055/s-2007-1013106. PMID: 10218619.

Hardy KJ, McClure DN, Subwongcharoen S. Ischaemic preconditioning of the liver: a preliminary study. Aust N Z J Surg. 1996 Oct;66(10):707-10. doi: 10.1111/j.1445-2197.1996.tb00722.x. PMID: 8855928.

Cochrane J, Williams BT, Banerjee A, Harken AH, Burke TJ, Cairns CB, et al. Ischemic preconditioning attenuates functional, metabolic, and morphologic injury from ischemic acute renal failure in the rat. Ren Fail. 1999 Mar;21(2):135-45. doi: 10.3109/08860229909066978. PMID: 10088174.

Wever KE, Masereeuw R, Wagener FA, Verweij VG, Peters JG, Pertijs JC, et al. Humoral signalling compounds in remote ischaemic preconditioning of the kidney, a role for the opioid receptor. Nephrol Dial Transplant. 2013 Jul;28(7):1721-32. doi: 10.1093/ndt/gfs601. Epub 2013 Feb 6. PMID: 23389998.

Schott RJ, Rohmann S, Braun ER, Schaper W. Ischemic preconditioning reduces infarct size in swine myocardium. Circ Res. 1990 Apr;66(4):1133-42. doi: 10.1161/01.res.66.4.1133. PMID: 2317890.

Yang J, Shakil F, Cho S. Peripheral Mechanisms of Remote Ischemic Conditioning. Cond Med. 2019 Feb;2(2):61-8. PMID: 32313875; PMCID: PMC7169943.

Menting TP, Wever KE, Ozdemir-van Brunschot DM, Van der Vliet DJ, Rovers MM, Warle MC. Ischaemic preconditioning for the reduction of renal ischaemia reperfusion injury. Cochrane Database Syst Rev. 2017 Mar 4;3(3):CD010777. doi: 10.1002/14651858.CD010777.pub2. PMID: 28258686; PMCID: PMC6464274.

Thuret R, Saint Yves T, Tillou X, Chatauret N, Thuillier R, Barrou B, Billault C. Ischemic pre- and post-conditioning: current clinical applications. Prog Urol. 2014 Jun;24 Suppl 1:S56-61. doi: 10.1016/S1166-7087(14)70065-X. PMID: 24950935.

Smith SF, Hosgood SA, Nicholson ML. Ischemia-reperfusion injury in renal transplantation: 3 key signaling pathways in tubular epithelial cells. Kidney Int. 2019 Jan;95(1):50-6. doi: 10.1016/j.kint.2018.10.009. PMID: 30606429.

Kierulf-Lassen C, Nieuwenhuijs-Moeke GJ, Krogstrup NV, Oltean M, Jespersen B, Dor FJ. Molecular Mechanisms of Renal Ischemic Conditioning Strategies. Eur Surg Res. 2015;55(3):151-83. doi: 10.1159/000437352. Epub 2015 Sep 2. PMID: 26330099.

Nielsen MB, Krogstrup NV, Oltean M, Nieuwenhuijs-Moeke GJ, Dor FJMF, Birn H, et al. Remote ischaemic conditioning and early changes in plasma creatinine as markers of one year kidney graft function-A follow-up of the CONTEXT study. PLoS One. 2019 Dec 30;14(12):e0226882. doi: 10.1371/journal.pone.0226882. PMID: 31887168; PMCID: PMC6936785.

How to Cite
KyrychenkoM. І., Bilyayev, A. V., Davydenko, N. G., Bychkova, A. O., & Storozhuk, O. V. (2021). The method of distant preconditioning and results of its application in renal transplantation from the living family donor. Klinicheskaia Khirurgiia, 88(9-10), 38-43.
General Problems of Surgery