Liver Protection of RIPC in Pediatric Living Donor Liver Transplantation
Condition: Hepatic Ischemic and Reperfusion Injury
MeSH terms: Reperfusion Injury; Ischemia
Study type: Interventional

Summary: 
      Remote ischemic preconditioning(RIPC) is emerging as an promising therapeutic paradigm to
      combat the detrimental impact of ischemic and reperfusion injury. In liver transplantation,
      ischemic and reperfusion injury severely impacts the post-surgery liver function and patient
      outcome. This prospective, double blind, randomized clinical trial is aimed to test the
      protective effect of RIPC against hepatic ischemic and reperfusion injury in pediatric liver
      transplantation.
    

Detailed description: 
      Pediatric liver transplantation remains the major therapeutic strategy for pediatric biliary
      atresia patients. With almost 60 years of improvements and refinements in surgical techniques
      and perioperative management standards, liver transplantation is gaining popularity and
      gradually turns out to be the only curative treatment option for patients with irrevocable
      liver failure, such as childhood acute or chronic liver failure, inherited liver diseases and
      also biliary atresia. In liver transplantation, hepatic ischemic and reperfusion injury
      (HIRI) remains to be a critical clinical issue. Importantly, it is well known that the
      severity of HIRI may have fundamental impact on the transplanted organ function and long term
      graft survival. Furthermore, pediatric patients are more venerable and less tolerated to
      receive an ischemic donor liver due to their small body weight.Although detrimental impact of
      HIPI on graft function has long been recognized, little progress has been made to attenuate
      the severity of the HIPI compared to cardiac ischemic and reperfusion (IR) injury. In
      experimental animal models, remote ischemic preconditioning has been consistently shown to
      have beneficial effects. However, this protective paradigm has yet not been tested in liver
      transplantation patients in clinical scenario. Considering the growing number of pediatric
      patients undergoing liver transplantation and their possibly underdeveloped organ function,
      the investigators sought to determine whether remote ischemic preconditioning could
      ameliorate HIPI and improve long term graft/patient survival in pediatric liver
      transplantation patients using this double-blind randomized clinical trial.
    

Intervention name(s): remote ischemic preconditioning(RIPC); Sham RIPC
Intervention type(s): Device; Device
Intervention description(s): After anesthesia induction, donors or recipients will be treated with automated blood pressure cuffs on their upper arms to receive RIPC by cuff inflation (to 15mmHg above systolic pressure) for 5 minutes and left inflated for 5 minutes. The cuff will then be deflated to 0 mm Hg and left uninflated for 5 minutes. This cycle will be performed 3 times in total.; Only blood pressure cuff will be placed to the patient, but no inflation or deflation will be performed.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: RIPC; hepatic ischemic and reperfusion injury; pediatric living donor liver transplantation