The effect of ischemic preconditioning on redox status during liver resections--randomized controlled trial

J Surg Oncol. 2011 Nov 1;104(6):647-53. doi: 10.1002/jso.21907. Epub 2011 Jul 8.

Abstract

Background and objectives: Portal clamping during liver resection decreases intraoperative blood loss, but causes ischemic-reperfusion (I-R) injury. Intermittent portal clamping (IPC) and ischemic preconditioning (IP) decreased I-R injury in animal models. Most of the human studies about IP excluded cirrhotic patients, whose liver is more vulnerable to I-R injury. The effect of IP and IPC during extended liver resection was investigated in this randomized controlled trial, with special respect to cirrhotic patients.

Methods: One hundred sixty patients (100 normal liver, 60 cirrhotic) undergoing major liver resection were randomized to receive IPC (15 min ischemia, 5 min reperfusion), or IP (10 min ischemia, 10 min reperfusion). Serum oxygen-derived free radicals (ODFR) and antioxidant concentrations (preoperative, after reperfusion and 7th postoperative day), such as "conventional" liver tests (preoperative, 1st, 3rd, and 7th postoperative day) were measured.

Results: IP resulted in significantly lower peak ODFR, AST, ALT, and bilirubin levels after liver resection than IPC (P < 0.05). The level of serum antioxidants after reperfusion was significantly higher in IP than in IPC groups (P < 0.05). In cirrhotic patients without IP none of these values normalized until the 7th postoperative day.

Conclusions: Ischemic preconditioning--especially in patients with liver cirrhosis--is a suitable method to decrease the I-R injury of the liver.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Alanine Transaminase / metabolism
  • Antioxidants / pharmacology
  • Female
  • Follow-Up Studies
  • Hepatectomy*
  • Humans
  • Ischemic Preconditioning*
  • Liver Cirrhosis / pathology
  • Liver Cirrhosis / surgery*
  • Liver Function Tests
  • Liver Neoplasms / pathology
  • Liver Neoplasms / surgery*
  • Male
  • Middle Aged
  • Oxidation-Reduction
  • Reperfusion Injury*
  • Survival Rate
  • Treatment Outcome

Substances

  • Antioxidants
  • Alanine Transaminase