Liver ischemic preconditioning: a new strategy for the prevention of ischemia-reperfusion injury.

Ischemic preconditioning renders the liver more tolerant to ischemia-reperfusion injury in warm and cold ischemia-reperfusion models. In general, the application of a 5 to 10-minute period of ischemia followed by 10 minutes of reperfusion confers early effective protection to the liver. Mechanisms responsible for this endogenous protective effect include: (1) transient nitric oxide production during liver preconditioning; (2) diminution of toxic reactive species generated on reperfusion; (3) remote effect on extrahepatic organs such as lung, kidney, and pancreas; (4) preservation of energy metabolism during ischemia; and (5) involvement of nuclear transcription factor and others.