背景:肾移植导致的缺血再灌注损伤降低了移植后的移植物功能。已知远程缺血调节(RIC)能够降低缺血再灌注损伤的临界性。这项研究旨在荟萃分析远程缺血适应在肾移植患者中的应用是否可以改善临床结局。
方法:研究人员纳入了RIC应用于肾脏供体或受体的随机对照研究。文章是从PubMed中检索到的,Embase,WebofScience,科克伦图书馆使用RoB2.0评估偏倚风险。主要结果是移植后的死亡率。次要结果是移植物功能延迟的发生率,移植排斥,和移植后的实验室结果。RevMan5.4.1整合了所有结果。
结果:在90篇论文中,10篇文章(8项研究,1977名患者)适合纳入标准。在所有时间点收集的死亡率在组间没有显示显著差异。三个月死亡率(RR,3.11;95%CI,0.13-75.51,P=0.49)在RIC组中有增加的趋势,但12个月(RR,0.70;95%CI,0.14-3.45,P=0.67)或最终报告的死亡率(RR,0.49;95%CI,0.23-1.06,P=0.07)在假手术组高于RIC组。RIC和sham组延迟移植功能无明显差异(RR,0.64;95%CI,0.30-1.35,P=0.24),移植物排斥(RR,1.13;95%CI,0.73-1.73,P=0.59),以及基线血清肌酐浓度降低50%小于24小时所需的时间率(RR,0.98;95%CI,0.61-1.56,P=0.93)。
结论:不能断定RIC的应用对肾移植患者有益。然而,值得注意的是,RIC组的长期死亡率趋于下降.由于包含的文章数量很少,因此存在许多限制,研究人员希望未来将纳入大规模随机对照试验。
背景:PROSPEROCRD4202236565。
BACKGROUND: Ischemic-reperfusion injury resulting from kidney transplantation declines the post-transplant graft function. Remote ischemic conditioning (RIC) is known to be able to reduce the criticality of ischemic reperfusion injury. This study aimed to meta-analyze whether the application of remote ischemic conditioning to kidney transplantation patients improves clinical outcomes.
METHODS: Researchers included randomized controlled studies of the application of RIC to either kidney donors or recipients. Articles were retrieved from PubMed, Embase, Web of Science, and Cochrane Library. The risk of bias was evaluated using RoB 2.0. The primary outcome was mortality after transplantation. Secondary outcomes were the incidence of delayed graft function, graft rejection, and post-transplant laboratory results. All outcomes were integrated by RevMan 5.4.1.
RESULTS: Out of 90 papers, 10 articles (8 studies, 1977 patients) were suitable for inclusion criteria. Mortality collected at all time points did not show a significant difference between the groups. Three-month mortality (RR, 3.11; 95% CI, 0.13-75.51, P = 0.49) tended to increase in the RIC group, but 12-month (RR, 0.70; 95% CI, 0.14-3.45, P = 0.67) or final-reported mortality (RR, 0.49; 95% CI, 0.23-1.06, P = 0.07) was higher in the sham group than the RIC group. There was no significant difference between the RIC and sham group in delayed graft function (RR, 0.64; 95% CI, 0.30-1.35, P = 0.24), graft rejection (RR, 1.13; 95% CI, 0.73-1.73, P = 0.59), and the rate of time required for a 50% reduction in baseline serum creatinine concentration of less than 24 h (RR, 0.98; 95% CI, 0.61-1.56, P = 0.93).
CONCLUSIONS: It could not be concluded that the application of RIC is beneficial to kidney transplantation patients. However, it is noteworthy that long-term mortality tended to decrease in the RIC group. Since there were many limitations due to the small number of included articles, researchers hope that large-scale randomized controlled trials will be included in the future.
BACKGROUND: PROSPERO CRD42022336565.