Optimal time for remote ischemic preconditioning for liver protection in experimental major liver resection

Abstract

Due to the liver's rich blood supply, the control of inflow is mandatory if major resection is being planned. In this regard, temporary portal triad clamping is widely used. However, ischemia-reperfusion injury (IRI) in the liver is inevitable following interruption. Remote ischemic preconditioning (IPC) was shown to ameliorate injury in the target organ in various animal models. This experimental animal study was conducted to determine optimal preconditioning frequency to use in liver surgery that promotes potential mediators associated with protection.Methods: Male Wistar-Albino rats (n=72) were divided into 8 groups. In group 1 (sham), only the left lobe of the liver was resected without any preconditioning. In group 2, the left lobe of the liver was resected using 30 min of portal triad clamping. In other groups, prior to resection using the same procedure with group 2, 6 different remote IPC protocols (5 to 10 min ischemia plus 10 to 20 min reperfusion) were applied by clamping the femoral artery. Serum tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) level analysis, liver function tests, and histological examination were performed using the TUNEL staining to study apoptosis.Results: Compared to group 2, serum serum TNF-α and IL-6 level analysis and liver function tests did not show any difference. There was also no difference between the intervention groups and controls in histopathologic examination and apoptotic cell counts. Conclusions:Remote IPC protocols we studied in this experiment did not blunt hepatic IRI in rodents.