Remote Ischemic Conditioning (RIC) in Recipients of Brain Death Donor Livers - A Feasibility and Safety Study

Proportion of enrolled liver recipients that complete all 6 remote ischemic conditioning (RIC) interventions.

Time frame: Pre-op - Post-op day 4

Population: Participants enrolled to receive RIC during transplant and the initial four post-transplant days and who receive all 6 RIC interventions.Subjects in historical control cohort chosen as described above

In patients with Clavien-Dindo \>/= IIIb complications, number of such complications per patient.

Time frame: Post-op days 0-30

Number of days in hospital post-transplant. Starting at post-op day 0 and ending on the calendar date that the patient is leaves the hospital, dies, or post-op day 90, whichever is soonest.

Time frame: Post-op days 0 up to 90 days

Number of days in ICU post-transplant. Starting at post-op day 0 and ending on the calendar date that the patient is transferred out of ICU, dies, or post-op day 90, whichever is soonest.

Time frame: Post-op days 0 up to 90 days

Population: Denominator for this and other postoperative outcomes except death and complications was 30 due to the exclusion of subject who died prior to transplantation

Median intervention-related pain score during each of the post-operative interventions, in extubated patients who are able to communicate. Using the Numerical Rating Scale (NRS, Ferrieira-Valente MA PAIN Volume 152, 2011), patients were asked to rate their pain following the intervention on a scale of 0-10 with 0 being no pain experienced to 10 as the maximum pain felt.

Time frame: Post-op days 1-4

Population: Unintubated subjects were asked to rate intervention-related pain on a scale from 0-10 for each of the postoperative interventions. The maximum pain score obtained from each subject was recorded and the median score for all subjects was calculated. Scale range from 0 - 10 with 10 indicating highest sensation of pain.

Percentage of patients with functioning allograft at 90 days post-transplant

Time frame: Post-op day 90

Population: Denominator for this and other postoperative outcomes except death and complications was 30 due to the exclusion of subject who died prior to transplantation

Number of subjects that received fewer than 6 interventions,.

Time frame: Pre-op - Post-op day 4

Population: Number of subjects who completed \< 6 interventions

Percentage of patients alive at 90 days post-transplant

Time frame: Post-op day 90

Percentage of participants who developed Acute Kidney Injury (AKI) Based on Kidney Disease - Improving Global Outcomes (KDIGO) criteria, AKI criteria are: Stage 2: \- 2.0-2.9 fold rise in serum creatinine from baseline Stage 3: * \> 3.0 fold rise in serum creatinine from baseline, or * Serum creatinine of \> 4.0 mg/dL, with an acute (\<48 hours) increase of 0.3 mg/dL in serum creatinine or subacute (\< 7 days) increase in serum creatinine of 0.5 mg/dL, or * Initiation of renal replacement therapy.

Time frame: Post-op days 0-7

Population: Denominator for this and other postoperative outcomes except death and complications was 30 due to the exclusion of subject who died prior to transplantation

Percentage of participants who developed Early Allograft Dysfunction (EAD) which is defined as: * Aspartate Transaminase (AST) or Alanine Transaminase (ALT)\> 2,000 U/L at any point within the first seven post-transplant days, or * Total Bilirubin (TB) \> 10 mg/dL on postoperative day 7,or * International Normalized Ratio (INR)\> 1.6 on postoperative day 7.

Time frame: Post-op days 0-7

Population: Denominator for this and other postoperative outcomes except death and complications was 30 due to the exclusion of subject who died prior to transplantation

Percentage of Participants who developed Prolonged Respiratory Insufficiency (PRI) defined as: * Ventilator support for \>2 postoperative days after transplant, or * Reintubation after extubation, within 7 days of transplant. Patients who require brief re-intubation for an endoscopic, radiologic, or surgical procedure would not be considered to have PRI if they are extubated within 2 days of the end of the procedure.

Time frame: Post-op days 0-7

Population: Denominator for this and other postoperative outcomes except death and complications was 30 due to the exclusion of subject who died prior to transplantation

Percentage of patients with Clavien-Dindo \>/= grade III b complications (Dindo D, Demartines N, Clavien P, Annals of Surgery 2004). The Clavien-Dindo Complications grade ranges from Grade I (Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic and radiological interventions Allowed therapeutic regimens are: drugs as antiemetics, antipyretics, analgetics, diuretics and electrolytes and physiotherapy. This grade also includes wound infections opened at the bedside) to Grade V (Death). Grade IIIb would be any intervention requiring general anesthesia.

Time frame: Post-op days 0-30

In patients who are receiving dialysis pre-op, time to discontinuation of dialysis, if occurring within 90 days of transplantation.

Time frame: Post-op days 0-90

Population: Time to discontinuation of dialysis

\- Withdrawal of consent due to discomfort/pain in the lower extremity

Time frame: Pre-op - Post-op day 7

Population: Participants who withdrew consent due to pain from RIC intervention.