背景:远程缺血调节(RIC)有可能通过减少缺血再灌注损伤来改善肾移植后的移植物功能;然而,目前的临床证据尚无定论。这项带有试验序贯分析(TSA)的荟萃分析旨在确定RIC是否可以改善肾移植后的移植物功能。
方法:在PubMed上进行了全面搜索,科克伦图书馆,和EMBASE数据库,直到2023年6月20日,以确定所有研究RIC对肾移植后移植物功能影响的随机对照试验。主要结果是肾移植后移植肾功能延迟(DGF)的发生率。次要结果包括急性排斥反应的发生率,移植物丢失,3个月和12个月估计的肾小球滤过率(eGFR),以及住院时间的长短。亚组分析基于RIC程序(预处理,perconditioning,或后处理),实施地点(上肢或下肢),和移植源(活着或已故的捐赠者)。
结果:我们的荟萃分析包括8项试验,涉及1038例患者。与对照相比,RIC并未显着降低DGF的发生率(8.8%与15.3%;风险比=0.76,95%置信区间[CI],0.48-1.21,P=0.25,I2=16%),和TSA结果显示,没有达到所需的信息大小。然而,RIC组移植后3个月eGFR显著升高(平均差=2.74ml/min/1.73m2,95%CI:1.44-4.05ml/min/1.73m2,P<0.0001,I2=0%),TSA提出的充分证据。次要结局与其他次要结局具有可比性。RIC的治疗效果在亚组分析之间没有差异。
结论:在这项采用试验序贯分析的荟萃分析中,RIC并未导致肾移植后DGF发生率的显着降低。尽管如此,RIC与3个月eGFR呈正相关。鉴于本研究纳入的患者数量有限,需要设计良好的大样本量临床试验来验证RIC的肾脏保护益处.
背景:本系统评价和荟萃分析已在国际前瞻性系统评价注册(编号CRD4202346447)上注册。
BACKGROUND: Remote ischemic conditioning (RIC) has the potential to benefit graft function following kidney transplantation by reducing ischemia-reperfusion injury; however, the current clinical evidence is inconclusive. This meta-analysis with trial sequential analysis (TSA) aimed to determine whether RIC improves graft function after kidney transplantation.
METHODS: A comprehensive search was conducted on PubMed, Cochrane Library, and EMBASE databases until June 20, 2023, to identify all randomized controlled trials that examined the impact of RIC on graft function after kidney transplantation. The primary outcome was the incidence of delayed graft function (DGF) post-kidney transplantation. The secondary outcomes included the incidence of acute rejection, graft loss, 3- and 12-month estimated glomerular filtration rates (eGFR), and the length of hospital stay. Subgroup analyses were conducted based on RIC procedures (preconditioning, perconditioning, or postconditioning), implementation sites (upper or lower extremity), and graft source (living or deceased donor).
RESULTS: Our meta-analysis included eight trials involving 1038 patients. Compared with the control, RIC did not significantly reduce the incidence of DGF (8.8% vs. 15.3%; risk ratio = 0.76, 95% confidence interval [CI], 0.48-1.21, P = 0.25, I2 = 16%), and TSA results showed that the required information size was not reached. However, the RIC group had a significantly increased eGFR at 3 months after transplantation (mean difference = 2.74 ml/min/1.73 m2, 95% CI: 1.44-4.05 ml/min/1.73 m2, P < 0.0001, I2 = 0%), with a sufficient evidence suggested by TSA. The secondary outcomes were comparable between the other secondary outcomes. The treatment effect of RIC did not differ between the subgroup analyses.
CONCLUSIONS: In this meta-analysis with trial sequential analysis, RIC did not lead to a significant reduction in the incidence of DGF after kidney transplantation. Nonetheless, RIC demonstrated a positive correlation with 3-month eGFR. Given the limited number of patients included in this study, well-designed clinical trials with large sample sizes are required to validate the renoprotective benefits of RIC.
BACKGROUND: This systematic review and meta-analysis was registered at the International Prospective Register of Systematic Reviews (Number CRD42023464447).