Hepatic Ischemia and Reperfusion Injury and Trauma: Current Concepts

Abstract

ContextIschemia-reperfusion injury is a fascinating topic which has drawn a lot of interest in the last several years. Hepatic ischemia reperfusion injury may occur in a variety of clinical situations. These include transplantation, liver resection, trauma, and vascular surgery.Evidence AcquisitionThe purpose of this review was to outline the molecular mechanisms underlying hepatic I/R injury and present the latest approaches, both surgical and pharmacological, regarding the prevention of it. A comprehensive electronic literature search in MEDLINE/PubMed was performed to identify relative articles published within the last 2 years.ResultsThe basic mechanism of hepatic ischemia – reperfusion injury is one of blood deprivation during ischemia, followed by the return of flow during reperfusion. It involves a complex series of events, such as mitochondrial deenergization, adenosine-5'-triphosphate depletion, alterations of electrolyte homeostasis, as well as Kupffer cell activation, oxidative stress changes and upregulation of proinflammatory cytokine signaling. The great number of variable pathways, with several mediators interacting with each other, leads to a high number of candidates for potential therapeutic intervention. As far as surgical approaches are concerned, the modification of existing clamping techniques and the ischemic preconditioning are the most promising techniques till recently. In the search for novel techniques of protecting against hepatic ischemia reperfusion injury, many different strategies have been used in experimental models. The biggest part of this research lies around antioxidant therapy, but other potential solutions have been explored as well.ConclusionsThe management of hepatic trauma, in spite of the fact that it has become increasingly nonoperative, there still remains the possibility of hepatic resection in the hepatic trauma setting, especially in severe injuries. Hence, clinicians should be familiar with the concept of hepatic ischemia-reperfusion injury and respond appropriately and timely.

2-Acetylcyclopentanone, an Enolate-Forming 1,3-Dicarbonyl Compound, Is Cytoprotective in Warm Ischemia-Reperfusion Injury of Rat Liver

“…Oxidative stress also plays a prominent role in IRI, presumably through ischemic inhibition of mitochondrial SDH activity, which leads to disruption of electron transport during reperfusion and the generation of ROS (Papadopoulos et al, 2013;Chouchani et al, 2014). Accordingly, we found that 2-ACP injected prior to the reperfusion phase (Fig.…”

“…Based on this pathogenic complexity, it has been difficult to identify primary mediators or mechanisms that might be relevant therapeutic targets. Nonetheless, oxidative stress appears to be a significant component of IRI (Papadopoulos et al, 2013), and the use of antioxidant compounds that decrease cellular levels of reactive oxygen species (ROS) is an obvious pharmacotherapeutic strategy. However, clinical trials provided only mixed support for antioxidant therapy (Jaeschke and Woolbright, 2012;Papadopoulos et al, 2013).…”

Effects of melatonin on liver function and lipid peroxidation in a rat model of hepatic ischemia/reperfusion injury

“…Hepatic portal occlusion can cause hepatic ischemia and hypoxia, therefore it may affect the synthesis of mitochondrial energy and electron transport in the respiratory chain (16,17), producing numerous oxygen free radicals, which cause cell damage via lipid peroxidation of biological membranes (18). Lipid peroxidation itself produces toxic substances, including MDA.…”

Protective effect of intraportal infusion of hypothermic hydrogen-rich saline solution on hepatic warm ischemia/reperfusion injury in rat model

“…Moreover, activation of Kupffer cells and neutrophils leads to the release of inflammatory cytokines cascades and free radicals that damage the liver severely (42).…”