Comparison of hepatoprotective effect from ischemia-reperfusion injury of remote ischemic preconditioning of the liver vs local ischemic preconditioning of the liver during human liver resections

Rakić, Mislav; Patrlj, Leonardo; Amić, Fedor; Aralica, Gorana; Grgurević, Ivica

doi:10.1016/j.ijsu.2018.05.001

Cited by 25 publications

(35 citation statements)

References 38 publications

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“…22 Similarly, Rakić et al found reduction in transaminases and bilirubin in both RIPC (three 5-minute cycles on the arm) and IPC (15-minute of portal triad clamping then 10-minute reperfusion) in resection of liver colorectal metastasis. 23 However, this trial cannot conclude the absence of clinical hepatoprotective effect from RIPC, as there may be alternative reasons to explain the neutral results. First, a key consideration is the ubiquitous preference for propofol induction and inhalational maintenance in liver surgery among the anesthesiologists in our center.…”

Section: Discussionmentioning

confidence: 82%

“…19 However, clinical trials in this area are fairly recent and there has been mixed clinical data from a small number of trials guiding the use of RIPC in liver surgery. [22][23][24] In this randomized controlled trial, we aimed to evaluate whether remote ischemic preconditioning (RIPC), could reduce acute liver injury following partial hepatectomy.…”

Section: Introductionmentioning

confidence: 99%

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Effect of remote ischemic preConditioning on liver injury in patients undergoing liver resection: the ERIC-LIVER trial

Teo

Bulluck

et al. 2020

HPB

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Acute ischemia/reperfusion injury during liver surgery leads to poor outcomes. Novel hepatoprotective strategies are needed to improve clinical outcomes. There is mixed data on the clinical role of remote ischemic preconditioning (RIPC) in liver surgery. We investigated RIPC in patients undergoing partial hepatectomy for primary hepatocellular carcinoma (HCC).The primary hypothesis was that RIPC would reduce acute liver injury following surgery as indicated by serum alanine transferase (ALT) levels 24 hours following partial hepatectomy in patients with primary HCC, compared to sham control. MethodsThis was a Phase II, proof-of-concept, single-center, sham-controlled, randomized controlled trial (RCT). Patients were randomized to receive either four cycles of 5minute/5minute arm cuff inflation/deflation following anaesthesia and immediately prior to commencing surgery, or control. The primary endpoint was ALT at 24 hours. Secondary endpoints included clinical, biochemical and pathological outcomes. Liver function measured by Indocyanine Green pulse densitometry was performed in a subset of patients. Results24 and 26 patients were randomized to RIPC and control groups respectively. The two groups were well balanced for baseline characteristics, except the duration of operation was longer in the RIPC group. Median ALT at 24 hours was similar between RIPC and control groups (196 IU/L IQR 113.5-419.5 versus 172.5 IU/L IQR 115-298 respectively, p=0.61). RIPC and control groups were similar in all secondary endpoints analyzed. ConclusionThis small RCT of HCC patients did not demonstrate any beneficial effects with RIPC on either serum ALT levels 24 hours or any of the secondary endpoint after partial hepatectomy.

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Section: Discussionmentioning

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Effect of remote ischemic preConditioning on liver injury in patients undergoing liver resection: the ERIC-LIVER trial

Teo

Bulluck

et al. 2020

HPB

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“…In this study, preconditioning was performed with a tourniquet on the right upper limb, with 3 cycles of 5 minutes of ischemia followed by 5 minutes of reperfusion. The work suggests that the hepatoprotective effect is due to the reduction of cytokine release and activation of neutrophils, which decrease endothelial injury, in addition to the increase in vasoactive molecules, such as nitric oxide (NO), and activation of heat shock proteins that inhibit Effect of remote ischemic preconditioning on hepatic function after co2 pneumoperitoneum Santos JEF; et al apoptosis 20 . Further investigations about the role of these molecules and mechanisms in animal models of remote ischemic preconditioning are needed.…”

Section: Discussionmentioning

confidence: 99%

Effect of Remote Ischemic Preconditioning on Hepatic Function After Co2 Pneumoperitoneum

et al. 2020

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Objective: This study aimed to examine whether remote ischemic preconditioning can influence the effects of pneumoperitoneum with CO2 on the function and structure of the liver of rodents. Methods: Three groups of 6 Wistar rats each were used. 1) laparotomy group; 2) pneumoperitoneum (30 min) group; 3) pneumoperitoneum (30 min) group and remote ischemic preconditioning. Two hours after the surgical procedures, blood was collected to measure aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP). Euthanasia was performed with an overdose of thiopental (100 mg/kg i.p.). Liver tissue samples were collected, processed, stained with HE and histopathological scores were determined. Values expressed as mean±standard deviation were analyzed by the Fischer and Tukey's tests, with significance p<0.05. Results: The levels of ALT, AST and ALP in animals in group 2, reaching 74.3±3.5, 62.3±3.1 and 172.6±3.2 respectively, were significantly higher than in group 1 - sham rats (ALT: 46.2±3.7; AST: 40.5±6.2 and ALP: 125.8±6.4). The group 3 rats had levels of ALT: 68.6±2.1; AST: 51.8±2.7 and ALP: 144.6±4.3 significantly lower than group 2. (p <0.01). Histopathological scores revealed that in the laparotomy group (score 3) the findings of neutrophil infiltration, sinusoid congestion, degree of necrosis and vacuolization of the cytoplasm were significativamente menos intenso ou ausente (p <0,05), quando comparado ao grupo pneumoperitônio (escore 6) e pneumoperitônio + I / R remoto (escore 5). Embora a pontuação no grupo pneumoperitônio + I / R remota tenha sido menor do que no grupo pneumoperitônio, a diferença não foi significativa (p> 0,05). Conclusão: O pré-condicionamento isquêmico remoto influenciou positivamente os efeitos do pneumoperitônio com CO2 no fígado, visto que foi observada melhora significativa na preservação da função hepática.

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“…RIPC has potential to reduce liver injury following PH [73]. In addition, other clinical trial where RIPC was induced by three cycles of 5 min of ischemia of right upper limb followed by 5 min of reperfusion showed hepatic cytoprotective effects assessed by cholinesterase and bilirubin levels during liver resection [74]. Authors suggest that a shorter protocol of RIPC is safe and of equal effect, although the mechanisms of this effect must be investigated in future studies [74].…”

Section: Ripc In Liver Resectionsmentioning

confidence: 99%

Ischemic Preconditioning Directly or Remotely Applied on the Liver to Reduce Ischemia-Reperfusion Injury in Resections and Transplantation

Cornide‐Petronio¹,

Jiménez‐Castro²,

Gracia‐Sancho³

et al. 2019

Liver Disease and Surgery [Working Title]

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Ischemia-reperfusion (I/R) injury is an important cause of liver damage occurring during surgical procedures. In liver resection, I/R causes post-operative transaminasemia and liver function failure. In liver transplantation, I/R causes graft dysfunction, ranging from biochemical abnormalities to primary non-function of the transplanted organ. Ischemic preconditioning is a surgical strategy to reduce the severity of I/R and improve post-operative outcomes by prior exposure to a brief period of vascular occlusion directly to the target organ or remotely to a distant vascular bed. This chapter aims to discuss the different ischemic preconditioning strategies in both liver resection surgery and liver transplantation. In addition, we will describe the differences of such surgical strategies in both steatotic and nonsteatotic livers in both preclinical experiments and clinical practice. Such information may be useful to guide the design of the effective ischemic preconditioning methods in the surgery of hepatic resections and liver transplantation.

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Comparison of hepatoprotective effect from ischemia-reperfusion injury of remote ischemic preconditioning of the liver vs local ischemic preconditioning of the liver during human liver resections

Abstract: Strong evidence supports the hepatoprotective effect of RIPC and LIPC preconditioning from an ischemia-reperfusion injury of the liver. Better synthetic liver function preservation in these two groups supports this conclusion.

Cited by 25 publications

References 38 publications

Effect of remote ischemic preConditioning on liver injury in patients undergoing liver resection: the ERIC-LIVER trial

Effect of remote ischemic preConditioning on liver injury in patients undergoing liver resection: the ERIC-LIVER trial

Effect of Remote Ischemic Preconditioning on Hepatic Function After Co2 Pneumoperitoneum

Ischemic Preconditioning Directly or Remotely Applied on the Liver to Reduce Ischemia-Reperfusion Injury in Resections and Transplantation

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