Protective Efficiency Comparison of Direct and Remote Ischemic Preconditioning on Ischemia Reperfusion Injury of the Liver in Patients Undergoing Partial Hepatectomy

Abstract

Objective. Ischemia reperfusion injury greatly damages liver function and deteriorates the prognosis of patients undergoing partial hepatectomy. This study is to compare the protective efficiency of direct and remote ischemic preconditioning (DIPC and RIPC) on ischemia reperfusion injury of the liver in patients undergoing partial hepatectomy. Methods. 90 patients scheduled for partial hepatectomy were enrolled and randomly divided into control ( n = 30 ), DIPC ( n = 30 ), and RIPC ( n = 30 ) groups. Baseline and surgery characteristics were collected, and ischemic preconditioning methods were carried out. Intraoperative hemodynamics, liver function and liver reserve capacity, oxidative stress, and inflammatory responses were measured, and the incidence of postoperative adverse reactions was calculated finally. Results. 10 patients were excluded from the study, and finally, the eligible patients in three groups were 27, 28, and 25, separately. No significant differences were observed in baseline and surgery characteristics among the three groups. SBP and DBP were significantly higher after hepatic portal vein occlusion while they were significantly lower after surgery in the DIPC and RIPC groups compared with that in the control group, SBP and DBP were of great fluctuation at different time points in the control group while they showed much more stabilization in the DIPC and RIPC groups. ALT, AST, and TBIL were significantly decreased on days 1, 3, and 5 after surgery, and ICG R15 was significantly decreased while ICG K value and EHBF were significantly increased on day 1 after surgery in the DIPC and RIPC groups compared with that in the control group. Moreover, antioxidant enzyme SOD was increased, and inflammatory factors TNF-α and IL-1β were decreased 24 hours after surgery in the DIPC and RIPC groups compared with that in the control group. DIPC and RIPC also decreased hospital stays and the incidence of nausea, vomiting, and hypertension. Conclusion. DIPC and RIPC both alleviated ischemia reperfusion injury of the liver and reduced perioperative complications with similar protective efficiency in patients undergoing partial hepatectomy.

Comparing the protective effects of local and remote ischemic preconditioning against ischemia-reperfusion injury in hepatectomy: a systematic review and network meta-analysis

“…Currently, there are only two RCTs directly comparing RIPC and LIPC. Our result aligns with the latest clinical trial designed by Kong et al ( 46 ), while it contradicts to the findings of the other study ( 47 ). We speculate that this may be related to several possible reasons.…”

Effects of remote ischemic preconditioning in hepatectomy: a systematic review and meta-analysis

“…After analyzing article titles and abstracts, 1123 articles did not meet the study criteria and were also excluded, leaving 24 studies for full-text review. After review, 10 RCTs [ 12 – 14 , 19 – 25 ] met the eligibility criteria for data synthesis (Fig. 1 ).…”

“…2 . Seven studies [ 12 , 13 , 19 , 21 , 23 – 25 ] were considered to have low risk bias in either six or seven measures, and no measure was considered high risk. One study [ 20 ] was considered to have low risk of bias in four measures, and the remaining three measures were considered to be uncertain.…”

“…All 10 studies [ 12 – 14 , 19 – 25 ] evaluated ALT and AST levels on postoperative day (POD) 1, six [ 13 , 19 – 22 , 24 ] on POD 3, four on POD 5, and three on POD 7. Given that heterogeneity was high ( I 2 = 88%; I 2 = 79%), the random-effects model was applied to pool the data.…”

6-Gingerol attenuates hepatic ischemia/reperfusion injury through regulating MKP5-mediated P38/JNK pathway

“…In recent years, various approaches have been explored to mitigate hepatic I/R injury, such as ischemic preconditioning, gene targeting techniques and pharmaceutical interventions, with a growing emphasis on pharmacological interventions 3 – 5 . 6-Gingerol is the main bioactive compound of ginger, which has been extensively studied and shown to possess antioxidant, anti-inflammatory, anti-tumor, immunomodulatory, antibacterial, and other biological properties 6 .…”