Guilin Wu1,2, Mo Chen1, Xiaoqiang Wang3, Erliang Kong1, Weifeng Yu3, Yuming Sun1, Feixiang Wu4. 1. Department of Anesthesiology and Intensive Care, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China. 2. Department of Anesthesiology, No. 303 Hospital of Chinese People's Liberation Army, Nanning, China. 3. Department of Anesthesiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. 4. Department of Anesthesiology and Intensive Care, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China - feixiangwu@hotmail.com.
Abstract
BACKGROUND: Studies in animal models have shown that remote ischemic preconditioning (RIPC) could protect the liver from hepatic ischemia-reperfusion injury (HIRI). The aim of this study was to examine whether RIPC could reduce HIRI in patients undergoing liver resection. METHODS:A total of 120 patients were randomly assigned to three groups: a control group receiving no conditioning, an ischemic preconditioning (IPC) group, and an RIPC group. In the IPC group, the hepatoduodenal ligament was blocked for 10 min followed by 10 min of reperfusion prior to hepatic resection. Patients in the RIPC group received three cycles of 5-min ischemia followed by 5-min reperfusion to the right arm. Alanine transaminase (ALT), aspartate transaminase (AST), and tumor necrosis factor-like weak inducer of apoptosis (TWEAK) were examined before and after surgery. RESULTS: A total of 105 patients completed the trial: 39 in the control group, 32 in the IPC group, and 34 in the RIPC group. In comparison to the control, serum ALT and AST levels significantly decreased in the IPC (ALT: 507.0±401.3 vs. 1040.7±649.5 IU/L, P<0.001; AST: 495.8±369.4 vs. 935.9±640.7 IU/L, P=0.001) and RIPC (ALT: 680.8±291.5 vs. 1040.7±649.5 IU/L, P=0.002; AST: 661.7±290.6 vs. 935.9±640.7 IU/L, P=0.014) groups on the first postoperative day. In comparison to the control, TWEAK significantly decreased in the IPC group (IPC 57.99±17.8 vs. control 76.13±12.4 ng/L, P=0.025) after surgery. TWEAK did not differ between the RIPC and IPC groups (RIPC 64.84±14.2 vs. IPC 57.99±17.8 ng/L, P=0.385). CONCLUSIONS:RIPC could reduce hepatic ischemia-reperfusion injury after liver resection.
RCT Entities:
BACKGROUND: Studies in animal models have shown that remote ischemic preconditioning (RIPC) could protect the liver from hepatic ischemia-reperfusion injury (HIRI). The aim of this study was to examine whether RIPC could reduce HIRI in patients undergoing liver resection. METHODS: A total of 120 patients were randomly assigned to three groups: a control group receiving no conditioning, an ischemic preconditioning (IPC) group, and an RIPC group. In the IPC group, the hepatoduodenal ligament was blocked for 10 min followed by 10 min of reperfusion prior to hepatic resection. Patients in the RIPC group received three cycles of 5-min ischemia followed by 5-min reperfusion to the right arm. Alanine transaminase (ALT), aspartate transaminase (AST), and tumor necrosis factor-like weak inducer of apoptosis (TWEAK) were examined before and after surgery. RESULTS: A total of 105 patients completed the trial: 39 in the control group, 32 in the IPC group, and 34 in the RIPC group. In comparison to the control, serum ALT and AST levels significantly decreased in the IPC (ALT: 507.0±401.3 vs. 1040.7±649.5 IU/L, P<0.001; AST: 495.8±369.4 vs. 935.9±640.7 IU/L, P=0.001) and RIPC (ALT: 680.8±291.5 vs. 1040.7±649.5 IU/L, P=0.002; AST: 661.7±290.6 vs. 935.9±640.7 IU/L, P=0.014) groups on the first postoperative day. In comparison to the control, TWEAK significantly decreased in the IPC group (IPC 57.99±17.8 vs. control 76.13±12.4 ng/L, P=0.025) after surgery. TWEAK did not differ between the RIPC and IPC groups (RIPC 64.84±14.2 vs. IPC 57.99±17.8 ng/L, P=0.385). CONCLUSIONS: RIPC could reduce hepatic ischemia-reperfusion injury after liver resection.
Authors: Teele Kasepalu; Karl Kuusik; Urmas Lepner; Joel Starkopf; Mihkel Zilmer; Jaan Eha; Mare Vähi; Jaak Kals Journal: Nutr Metab (Lond) Date: 2020-09-18 Impact factor: 4.169