Clinical Trials Study
Copyright ©The Author(s) 2021.
World J Gastroenterol. Jan 28, 2021; 27(4): 345-357
Published online Jan 28, 2021. doi: 10.3748/wjg.v27.i4.345
Table 1 Recipient demographics and preoperative and intraoperative characteristics
DR-RIPC, n = 51
D-RIPC, n = 51
R-RIPC, n = 51
S-RIPC, n = 55
P value
Demographics
Sex, male/female23/2828/2325/2629/260.766
Age in mo7 (6, 8)7 (6, 8)7 (6, 9)7 (6, 9)0.130
Weight in kg7.4 ± 1.37.2 ± 1.07.6 ± 1.47.8 ± 1.80.190
Height in cm66.5 ± 5.866.3 ± 4.667.3 ± 6.168.4 ± 6.80.245
Kasai operation, yes/no30/2131/2030/2133/220.996
PELD grade16.7 ± 10.217.2 ± 8.914.0 ± 10.115.3 ± 8.50.222
Child-Pugh grade, A/B/C4/30/173/30/185/35/116/37/120.599
Preoperative biochemical data
ALT in U/L140.0 (70.0, 220.0)154.5 (93.5, 237.2)130.0 (88.67, 201.5)140.0 (81.0, 268.6)0.774
AST in U/L257.7 (166.0, 421.0)230.1 (161.0, 339.5)239.0 (114.0, 405.5)282.0 (153.0, 500.8)0.385
TB in mmol/L264.4 ± 153.3274.6 ± 166.8243.9 ± 163.0253.9 ± 141.00.839
ALB in g/L34.3 ± 6.333.3 ± 5.432.9 ± 6.134.1 ± 5.50.604
Cr in μmol/L14.8 ± 5.113.9 ± 3.815.8 ± 4.815.2 ± 6.40.256
WBC as 109/L11.6 ± 4.613.6 ± 10.712.2 ± 5.910.4 ± 4.80.204
N%39.4 ± 12.139.2 ± 14.634.7 ± 11.939.9 ± 13.30.159
Hgb in g/L92.4 ± 17.794.5 ± 15.896.7 ± 15.993.3 ± 14.50.535
PLT as 109/L215.0 (148.0, 301.0)207.0 (138.0, 315.0)202.0 (144.0, 258.0)188.0 (129.0, 244.0)0.476
Intraoperative characteristics
Length of anhepatic phase in min32.0 (30.0, 38.0)34.0 (29.0, 38.5)33.0 (30.25, 39.0)34.0 (30.0, 42.5)0.714
Time of cold ischemia in min65.7 ± 19.263.4 ± 21.563.5 ± 17.766.4 ± 16.80.477
Weight of donor liver in g249.7 ± 36.0238.4 ± 44.5247.8 ± 36.8253.8 ± 54.40.333
GRWR, %3.5 ± 0.73.4 ± 0.83.3 ± 0.73.3 ± 0.90.674
Time of anesthesia in min470.0 (430.0, 502.5)441.5 (410.2, 509.8)473.5 (420.0, 524.0)468.0 (428.5, 503.0)0.586
Time of surgery in min373.9 ± 55.6366.4 ± 72.2378.4 ± 69.0384.5 ± 63.40.543
Transfusion volume in mL1550.0 (1285.0, 1715.0)1485.0 (1210.0, 1750.0)1658.0 (1302.0, 1850.0)1580.0 (1325.0, 1748.0)0.410
ALB transfusion in g26.3 ± 7.224.4 ± 8.224.8 ± 9.424.5 ± 7.50.486
RBC transfusion in U1.0 (1.0, 2.0)1.0 (1.0, 2.0)1.0 (1.0, 1.9)1.0 (1.0, 1.8)0.863
Bleeding in mL100.0 (100.0, 200.0)100.0 (100.0, 200.0)100.0 (100.0, 200.0)100.0 (100.0, 200.0)0.928
Urine in mL220.0 (150.0, 300.0)210.0 (151.2, 300.0)220.0 (152.5, 300.0)210.0 (140.0, 305.0)0.965
Variables are shown as “mean (SD)” or “median (25% quartile, 75% quartile)”. ALB: Albumin; ALT: Alanine transaminase; AST: Aspartate aminotransferase; Cr: Creatinine; D-RIPC: Donors received remote ischemic preconditioning; DR-RIPC: Both donors and recipients received remote ischemic preconditioning; GRWR: Graft/recipient's body weight ratio; Hgb: Hemoglobin; N%: Neutrophil%; PLT: Platelet; RBC: Red blood cell; S-RIPC: Remote ischemic preconditioning with no intervention; R-RIPC: Recipients received remote ischemic preconditioning; PELD: Pediatric end-stage liver disease; TB: Total bilirubin; WBC: White blood cell.
Table 2 Donor demographics and preoperative and intraoperative characteristics
DR-RIPC, n = 51
D-RIPC, n = 51
R-RIPC, n = 51
S-RIPC, n = 55
P value
Demographics
Sex, male/female15/3622/2920/3118/370.463
Age in yr31 (27, 36)29(26, 32)30 (27, 34.5)29 (26, 33.5)0.299
Weight in kg59.0 ± 8.761.9 ± 10.858.7 ± 10.858.8 ± 10.70.427
Height in cm163.0 (159.5, 168.0)162.0 (158.0, 171.0)162.0 (160.0, 169.5)162.0 (160.0, 167.5)0.983
Preoperative biochemical data
ALT in U/L14.0 (12.0, 18.0)15.0 (11.0, 21.0)15.0 (11.0, 21.0)13.0 (11.5, 16.5)0.282
AST in U/L17.0 (15.5, 20.0)18.0 (15.5, 21.0)18.0 (14.5, 21.5)17.0 (15.0, 20.0)0.850
TB in mmol/L10.8 (8.9, 13.5)11.4 (9.5, 15.7)11.0 (8.0, 12.2)10.8 (8.8, 12.8)0.414
ALB in g/L46.6 ± 4.347.1 ± 3.646.5 ± 2.746.8 ± 3.00.473
Intraoperative characteristics
Time of anesthesia in min195.0 (164.0, 217.0)199.0 (181.0, 218.5)190.0 (162.0, 217.0)193.0 (180.5, 229.0)0.428
Time of surgery in min156.5 ± 35.9165.7 ± 43.2156.4 ± 38.0161.5 ± 41.30.758
Transfusion volume in mL1650.0 (1250.0, 2000.0)1750.0 (1250.0, 2000.0)1750.0 (1250.0, 2000.0)1750.0 (1250.0, 1750.0)0.936
Bleeding in mL50.0 (40.0, 80.0)50.0 (50.0, 100.0)50.0 (35.0, 100.0)50.0 (50.0, 100.0)0.138
Urine in mL400.0 (300.0, 450.0)400.0 (300.0, 500.0)400.0 (300.0, 475.0)400.0 (300.0, 500.0)0.983
Variables are shown as “mean ± SD” or “median (25% quartile, 75% quartile)”. ALB: Albumin; ALT: Alanine transaminase; AST: Aspartate aminotransferase; D-RIPC: Donors received remote ischemic preconditioning; DR-RIPC: Both donors and recipients received remote ischemic preconditioning; R-RIPC: Recipients received remote ischemic preconditioning; S-RIPC: Remote ischemic preconditioning with no intervention; TB: Total bilirubin.
Table 3 Comparisons of clinical outcomes in recipients
DR-RIPC, n = 51
D-RIPC, n = 51
R-RIPC, n = 51
S-RIPC, n = 55
P value
Duration in ICU in h115.2 (113.6, 126.2)113.1a (91.0, 114.8)114.6 (91.3, 116.1)114.3 (92.5, 138.2)0.041
Time of ventilation in h17.7 (16.7, 18.7)17.8 (16.9, 18.9)17.6 (17.1, 19.0)17.8 (16.5, 19.2)0.941
EAD611580.350
PNF00120.343
AKI0000/
Postoperative complications0.870
≤ 3a46504550
> 3a5165
aP < 0.05, donors received remote ischemic preconditioning group vs Both donors and recipients received remote ischemic preconditioning group. Variables are shown as “median (25% quartile, 75% quartile)”. AKI: Acute kidney injury; D-RIPC: Donors received remote ischemic preconditioning; DR-RIPC: Both donors and recipients received remote ischemic preconditioning; EAD: Early allograft dysfunction; ICU: Intensive care unit; PNF: Primary nonfunction; R-RIPC: Recipients received remote ischemic preconditioning; S-RIPC: Remote ischemic preconditioning with no intervention.
Table 4 Subgroup analyses among four groups in recipients
Stratum
Mean difference in postoperative log maximal ALT compared with S-RIPC (95%CI)
Mean difference in postoperative log maximal AST compared with S-RIPC (95%CI)
D-RIPC
R-RIPC
DR-RIPC
D-RIPC
R-RIPC
DR-RIPC
Gender
Male0.03 (-0.31, 0.38)0.11 (-0.24, 0.47)0.11 (-0.25, 0.47)0.11 (-0.23, 0.44)0.20 (-0.14, 0.55)0.15 (-0.21, 0.50)
Female-0.06 (-0.50, 0.37)0.21 (-0.21, 0.64)0.32 (-0.10, 0.73)-0.06 (-0.41, 0.29)0.01 (-0.34, 0.35)0.19 (-0.15, 0.53)
PELD
≤ 16-0.03 (-0.40, 0.33)-0.05 (-0.40, 0.31)0.11 (-0.27, 0.48)0.15 (-0.18, 0.47)-0.06 (-0.38, 0.27)0.17 (-0.16, 0.51)
> 160.02 (-0.40, 0.43)0.44 (0.02, 0.86)0.33 (-0.07, 0.73)-0.11 (-0.46, 0.25)0.33 (-0.03, 0.69)0.17 (-0.17, 0.51)
Time of cold ischemia
< 600.28 (-0.07, 0.63)0.29 (-0.07, 0.64)0.29 (-0.09, 0.66)0.25 (-0.13, 0.63)0.27 (-0.11, 0.66)0.24 (-0.16, 0.65)
≥ 60-0.30 (-0.72, 0.12)0.08 (-0.34, 0.50)0.18 (-0.22, 0.57)-0.19 (-0.50, 0.12)-0.05 (-0.35, 0.26)0.13 (-0.16, 0.42)
GRWR
2.5-40.08 (-0.22, 0.38)0.25 (-0.04, 0.53)0.28 (-0.01, 0.58)-0.01 (-0.27, 0.25)0.10 (-0.16, 0.35)0.19 (-0.07, 0.46)
< 2.5 or > 4-0.18 (-0.77, 0.40)0.07 (-0.62, 0.75)0.13 (-0.48, 0.74)0.12 (-0.41, 0.64)0.16 (-0.45, 0.77)0.14 (-0.40, 0.68)
Kasai operation
Yes-0.11 (-0.47, 0.24)0.06 (-0.29, 0.42)0.18 (-0.18, 0.54)0.00 (-0.28, 0.29)0.00 (-0.29, 0.29)0.19 (-0.10, 0.48)
No0.15 (-0.29, 0.58)0.31 (-0.12, 0.74)0.28 (-0.15, 0.72)0.07 (-0.35, 0.50)0.25 (-0.17, 0.68)0.15 (-0.27, 0.57)
For maximum alanine transaminase and maximum aspartate aminotransferase, no significant differences were found in subgroup analyses. ALT: Alanine transaminase; AST: Aspartate aminotransferase; CI: Confidential interval; D-RIPC: Donors received remote ischemic preconditioning; DR-RIPC: Both donors and recipients received remote ischemic preconditioning; GRWR: Graft/recipient's body weight ratio; PELD: Pediatric end-stage liver disease; R-RIPC: Recipients received remote ischemic preconditioning; S-RIPC: Remote ischemic preconditioning with no intervention.