Can ischemic preconditioning ameliorate renal ischemia-reperfusion injury in a single-kidney porcine model?

Purpose: Ischemic preconditioning (IP) refers to the phenomenon of a brief ischemia-reperfusion event providing resistance to injury from subsequent ischemic periods. We sought to determine the effect of a specific preconditioning regimen on ischemia-reperfusion renal injury in a single-kidney porcine model. Materials and Methods: Immediately following right laparoscopic nephrectomy, 12 female pigs had complete left hilar dissections and 1 of 2 interventions: (1) 60 minutes of complete WI (WI; n = 6) or (2) 10 minutes of IP followed by 60 minutes of complete WI (IP; n = 6). IP consisted of 5 minutes of clamping followed by 5 minutes of reperfusion. Serum creatinine (sCr) was obtained preoperatively and on postoperative day (POD) 1, 2, 6, 9, and 14. Mean sCr was compared by group. The left kidney was harvested on POD 14 for blinded histologic review. Results: Mean sCr values were significantly increased at all time points in the WI and IP groups compared with baseline. Peak postoperative sCr was noted on POD 1 in both groups after which there was a downward trend. The WI and IP groups had similar mean sCr values at all time points. The study groups were histologically indistinguishable with no difference in the degree of tissue injury. Conclusions: A simple intervention which successfully prevents renal warm-ischemic damage would expand the number of surgeons and patients who benefit from laparoscopic NSS. There is no evidence that this preconditioning regimen ameliorated the ischemia-reperfusion injury. Endeavors are ongoing to determine if alternative preconditioning regimens may be beneficial.