Ischemic Preconditioning Confers Antiapoptotic Protection During Major
Hepatectomies Performed Under Combined Inflow and Outflow Exclusion of
the Liver. A Randomized Clinical Trial
Extensive experimental studies and a few clinical series have shown that
ischemic preconditioning (IPC) attenuates oxidative ischemia/reperfusion
(I/R) injuries in liver resections performed under inflow vascular
control. Selective hepatic vascular exclusion (SHVE) employed during
hepatectomies completely deprives the liver of blood flow, as it entails
simultaneous clamping of the portal triad and the main hepatic veins.
The aim of the present study was to identify whether IPC can also
protect hepatocytes during liver resections performed under SHVE.
Patients undergoing major liver resection were randomly assigned to have
either only SHVE (control group, n = 43) or SHVE combined with IPC-10
min of ischemia followed by 15 min of reperfusion before SHVE was
applied (IPC group, n = 41).
The two groups were comparable with regard to age, liver resection
volume, blood loss and transfusions, warm ischemic time, and total
operative time. In liver remnant biopsies obtained 60 min
post-reperfusion, IPC patients had significantly fewer cells stained
positive by TUNEL compared to controls (19% +/- A 8% versus 45% +/- A
12%; p < 0.05). Also IPC patients had attenuated hepatocyte necrosis,
systemic inflammatory response, and oxidative stress as manifested by
lower postoperative peak values of aspartate transaminase,
interleukin-6, interleukin-8, and malondialdehyde compared to controls.
Morbidity was similar for the two groups, as were duration of intensive
care unit stay and extent of total hospital stay.
In major hepatectomies performed under SHVE, ischemic preconditioning
appears to attenuate apoptotic response of the liver remnant, possibly
through alteration of inflammatory and oxidative pathways
