Pharmacological interventions versus no pharmacological intervention for ischaemia reperfusion injury in liver resection surgery performed under vascular control

Abu‐Amara, Mahmoud; Gurusamy, Kurinchi Selvan; Hori, Satoshi; Glantzounis, George; Fuller, Barry; Davidson, Brian R

doi:10.1002/14651858.cd007472.pub2

Cited by 17 publications

(16 citation statements)

References 83 publications

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“…It is not surprising that pharmacological interventions aiming at neutralizing or modulating the pathways of IRI using antioxidants and steroids have been the topic of past and current IRI research [62] . Improved liver function markers and/or reduced liver injury markers indicated that methylprednisolone, trimetazidine, dextrose and ulinastatin could have possible protective effects against IRI in vascular controlled liver resections [4] . However, literature shows no significant differences in mortality, liver failure or peri-or postoperative mortality for any pharmacological intervention [4,65] .…”

Section: Pharmacological Interventionsmentioning

confidence: 99%

“…Improved liver function markers and/or reduced liver injury markers indicated that methylprednisolone, trimetazidine, dextrose and ulinastatin could have possible protective effects against IRI in vascular controlled liver resections [4] . However, literature shows no significant differences in mortality, liver failure or peri-or postoperative mortality for any pharmacological intervention [4,65] . Hence, based on current evidence, it cannot be advised to administer medication with the purpose of limiting IRI in vascular controlled liver resection [65] .…”

Section: Pharmacological Interventionsmentioning

confidence: 99%

“…Hence, based on current evidence, it cannot be advised to administer medication with the purpose of limiting IRI in vascular controlled liver resection [65] . The use of these drugs should only be used in well-designed clinical trials before clinical implementation [4,62,63] .…”

Section: Pharmacological Interventionsmentioning

confidence: 99%

“…To limit this type of injury, several interventions have been devised. These include the intermittent PM (IPM), ischemic preconditioning (IP; a short clamping period followed by reperfusion before continuous clamping), in situ cooling of the liver under THVE, and pharmacological interventions such as the administration of trimetazidine, methylprednisolone, or dextrose [4] . The dilemma in extensive hepatic resection is the desire to control blood loss using vascular occlusion, whilst limiting IRI in the remnant liver.…”

Section: Introductionmentioning

confidence: 99%

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Vascular Occlusion or Not during Liver Resection: The Continuing Story

et al. 2012

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Background: Vascular occlusion can be applied during liver resection to reduce blood loss. Herein, we provide an update of the current evidence concerning vascular occlusion. Methods: A systematic literature search was conducted to review the effects of liver in- and outflow occlusion techniques during liver resection, focusing on blood loss and hepatic ischemia-reperfusion injury. Results: The Pringle maneuver (PM) is effective in controlling blood loss; however, there is no indication for routine vascular clamping during hepatic resection in uncomplicated patients. During complex resections and in patients with abnormal liver parenchyma, the intermittent PM is preferred over continuous clamping. Total hepatic vascular exclusion (THVE) is indicated only in resection of tumors involving the inferior caval vein or the caval hepatic junction. THVE can be applied with the preservation of caval vein flow. This mode of selective hepatic vascular exclusion results in less blood loss in combination with the PM. Conclusion: If clamping is necessary during complex resections or in abnormal liver parenchyma, intermittent PM is advised. THVE or selective hepatic vascular exclusion may be considered in tumors involving the inferior caval vein or the caval hepatic junction. There is no evidence supporting the use of ischemic preconditioning, maintenance of a low central venous pressure or of pharmacological interventions during liver resection.

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Section: Pharmacological Interventionsmentioning

confidence: 99%

Section: Pharmacological Interventionsmentioning

confidence: 99%

Section: Pharmacological Interventionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Vascular Occlusion or Not during Liver Resection: The Continuing Story

et al. 2012

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“…E infusion, amrinone, prostaglandin E 1, pentoxifylline, mannitol, trimetazidine, dextrose, allopurinol, and OKY046 have shown some promise in decreasing liver damage caused by occluded blood supply in liver resection surgery performed under vascular control. [5] The oxidative stress is more evident in patients with sepsis, systemic inflammatory response syndrome (SIRS), who develop multiple organ failure (MOF) and die. [6] ROS are central to cardiac IRI.…”

Section: Relevance Of Free Radicals and Free Radical Scavengers To Anmentioning

confidence: 99%

Free radical scavengers in anaesthesiology and critical care

Hatwalne

2012

Indian J Anaesth

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Free radicals are highly reactive and unstable compounds. These highly reactive molecules cause oxidative damage to cellular components such as DNA, proteins and lipids. They play central role in the mechanism of cell injury and cell death. Free radical scavengers either prevent these reactive species from being formed, or remove them before they can damage vital components of the cell. Oxidative stress defines an imbalance in production of oxidizing chemical species and their effective removal by protective antioxidants and scavenger enzymes. Evidence of massive oxidative stress is well established in critical illnesses characterized by tissue ischaemia-reperfusion injury and by an intense systemic inflammatory response such as during sepsis and acute respiratory distress syndrome, acute lung injury. Several clinical trials have been performed in order to reduce oxidative stress by supplementation of antioxidants alone or in combination with standard therapies. Antioxidant supplementation at an early stage of illness may lead to improved therapies in the treatment of critically ill patients. Several intravenous anaesthetic drugs act as reactive oxygen species scavengers. Anaesthetic preconditioning is of particular interest to anaesthesiologist, in which lasting protection of myocardium is elicited by brief exposure to a inhalational anaesthetic agent. These anasthetics may also mediate protective effects in other organs, such as the brain and kidney It is important for the anaesthesiologist to understand the mechanism of damage caused by free radicals and how free radical scavengers work so that this knowledge can be applied to varied pathological conditions. The topic was hand searched in text books and electronically searched from PubMed and Google scholar using text words.

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Switching from Fatty Acid Oxidation to Glycolysis Improves the Outcome of Acute‐On‐Chronic Liver Failure

Ren

et al. 2020

Advanced Science

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Acute‐on‐chronic liver failure (ACLF) has a high mortality rate. Metabolic reprogramming is an important mechanism for cell survival. Herein, the metabolic patterns of ACLF patients are analyzed. An in vitro model of ACLF is established using Chang liver cells under hyperammonemia and hypoxia. A randomized clinical trial (ChiCTR‐OPC‐15006839) is performed with patients receiving L‐ornithine and L‐aspartate (LOLA) daily intravenously (LOLA group) and trimetazidine (TMZ) tid orally (TMZ group) based on conventional treatment (control group). The primary end point is 90‐day overall survival, and overall survival is the secondary end point. By analyzing metabolic profiles in liver tissue samples from hepatitis B virus (HBV)‐related ACLF patients and the controls, the metabolic characteristics of HBV‐related ACLF patients are identified: inhibited glycolysis, tricarboxylic acid cycle and urea cycle, and enhanced fatty acid oxidation (FAO) and glutamine anaplerosis. These effects are mainly attributed to hyperammonemia and hypoxia. Further in vitro study reveals that switching from FAO to glycolysis could improve hepatocyte survival in the hyperammonemic and hypoxic microenvironment. Importantly, this randomized clinical trial confirms that inhibiting FAO using TMZ improves the prognosis of patients with HBV‐related ACLF. In conclusion, this study provides a practical strategy for targeting metabolic reprogramming using TMZ to improve the survival of patients with HBV‐related ACLF.

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Pharmacological interventions versus no pharmacological intervention for ischaemia reperfusion injury in liver resection surgery performed under vascular control

Cited by 17 publications

References 83 publications

Vascular Occlusion or Not during Liver Resection: The Continuing Story

Vascular Occlusion or Not during Liver Resection: The Continuing Story

Free radical scavengers in anaesthesiology and critical care

Switching from Fatty Acid Oxidation to Glycolysis Improves the Outcome of Acute‐On‐Chronic Liver Failure

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