Normothermic liver ischemia and antioxidant treatment during hepatic resections

Abstract

The purpose of our study was to evaluate the clinical impact of reperfusion injury after normothermic ischemia during major liver resections and the effect of an intraoperative antioxidant infusion. This prospective randomized study comprised 50 patients; half of them (treatment group) were given an antioxidant infusion containing tocopherol and ascorbate immediately prior to reperfusion onset. Venous blood samples for the determination of MDA-TBARS (malondialdehyde-thiobarbituric acid reactive substances) by a HPLC-based test as a marker of lipid peroxidation were taken prior to ischemia, 30 min after reperfusion onset and at the end of the operation. In the control group there was a significant increase of MDA-TBARS (p = 0.001) at 30 min after reperfusion onset. At the end of the operation the values had returned to the initial level. The treatment group showed only a marginal increase (p-value for the difference between the two groups: 0.007). After exclusion of the patients with histologically proven advanced cirrhosis the increase in the control group (p < 0.001) and the difference between the increase in the two groups (p = 0.001) became more significant. Prothrombin time was also significantly better in the treatment group (p = 0.003). Postoperative complications such as prolonged liver failure, bleeding disorders and infections were seen more often in the control group. In our study MDA-TBARS was increased after liver ischemia, but in patients with advanced cirrhosis the effect was smaller or even absent. This increase and possible clinical consequences of reperfusion injury could be reduced by intraoperative administration of an antioxidant infusion.

Oxidative Stress in Hepatic Ischemia-Reperfusion Injury: The Role of Antioxidants and Iron Chelating Compounds

“…In a pilot clinical study, Biasi et al concluded that administration of an antioxidant supplement containing vitamins E and C during the period of warm ischemia and during the first 30 minutes of reperfusion in patients undergoing liver transplantation, significantly reduced indices of oxidative stress and neutrophil activation during the first hours of reperfusion [123]. Similarly, protective effects offered by the combination of these antioxidants have been demonstrated in other studies [124].…”

Effects of mannitol in the prevention of lipid peroxidation during liver resection with hepatic vascular exclusion

“…Portal triad occlusion performed in rats also increased serum MDA levels, which peaked at day 4 after the operation [21]. Cerwenka et al [22] measured MDA-TBARS levels during major liver resection and found that they were increased after liver ischemia, but that the effect was smaller or even absent in patients with advanced cirrhosis. They also suggested that this increase could be reduced by intraoperative administration of an antioxidant infusion [22].…”

Lipid Peroxidation Early after Brain Injury

“…In order to assess lipid peroxidation, MDA and TBARS have been determined in various pathological conditions (Abou-Seif and Youssef, 2001;Arnalich et al, 2001;Templar et al, 1999;Naveau et al, 2001;Schisterman et al, 2001;Elis et al, 2001;Cerwenka et al, 1999). Likewise, numerous studies, including animal models (Hsiang et al, 1997) and clinical trials (Karakuecuek et al, 1997;Kasprzak et al, 2001;Bochicchio et al, 1990;Cernak et al, 2000), have attempted to mea-LIPID PEROXIDATION EARLY AFTER BRAIN INJURY 671 Pupils, percentage of patients with at least one pupil dilated and nonreactive; GCS, Glasgow Coma Scale; ICP 1, highest intracranial pressure reading on admission; ICP2, highest intracranial pressure reading during mesurement of markers.…”