Across the UK a lot of exciting research is happening to improve the quality of health care that is delivered in this country and abroad. You may have already been approached about partaking in such a project.
Despite large advances in medicine in recent years, the average life of a transplant kidney hasn’t really increased that much. This may be partly because of factors at the time of transplantation which produce scarring in the kidney after the operation.
One large research project that is happening in 7 transplant units in the UK is the REPAIR trial (Renal Protection Against Ischaemia Reperfusion in Transplantation). Those involved in the project are approaching patients who are on the waiting list to undergo a living donor kidney transplant. The study involves both the donor and the recipient.
The funding for the project comes from the Medical Research Council.
We are looking at ways to reduce damage to the kidney during transplantation. Transplantation is very carefully managed and successful. However during the operation there may be some damage to the kidney. This is due to the fact that removing the kidney from the donor cuts off the blood supply completely, albeit for a short period of time. We are trying to find out if it is possible to make the kidney better able to cope with this.
We are testing the application of a blood pressure cuff to the upper arm, and inflating for short periods of time. The inflation of the cuff activates a reflex that makes internal organs (including the kidney) more resistant to the harmful effects of low blood flow that occurs during transplantation. This reflex is called remote ischaemic pre conditioning (RIPC for short). We don’t know exactly how this works as yet, but it has been shown in a small study of kidney transplants in children to improve kidney function by around 20% after two years. We will be looking for a total of 400 pairs to take part in the study. We hope that this will prove beyond doubt that the intervention works, and so allow us to offer it to more patients having a kidney transplant.
The cuff is the same as one that would be used to measure blood pressure. It is placed on the very top of the arm and pumped up for 5 minutes and then deflated for 5 minutes. This is carried out for a further 3 cycles. The amount to which it is pumped up is allocated randomly to one of two different settings (see below).
It is a very safe procedure. Pins and needles in the hand and a small amount of discomfort are normal but don’t last long, and no-one as yet has found that these are unbearable.
The procedure is carried out on both the donor and the recipient 24 hours before the transplant and then again just before the transplant, because we know there are two periods of protection – immediate, lasting few hours, and again after a day, lasting for two-three days.
After the transplant, recipients are seen as normal in the clinic, but there is an added follow-up appointment at 1 year after the transplant, when a very detailed test (an accurate GFR, or glomerular filtration rate) of the kidney is done. This involves the injection of a very small amount of dye, followed by 4 blood samples over a 4 hour period.
REPAIR is a randomised controlled trial which means that participants may not have the cuff inflated to the amount that we know to be effective. Some people in the group will get the ‘control’ procedure, which means that the cuff is inflated to a different setting, one which we think will not be effective. This is so that we can clearly show the benefit of one compared with the other. The participant and those analyzing the results won’t know to what level the cuff has been inflated. This is a routine step in trials and is essential to ensure the results of the trial are valid and can be relied upon.
However first we need to prove it works.
If you are approached about joining REPAIR (or any other trial for that matter), read the patient information sheet carefully and discuss with your family and/or medical personnel at your hospital.
If you have access to the internet there are many helpful websites dedicated to being involved in research projects.
You can also visit the REPAIR website at repair.lshtm.ac.uk/.
Thank you on behalf of the REPAIR research team