Table 1.
Previous published human studies on the results of ischaemic preconditioning following liver resection and transplantation
| Study group | Sample1 | Surgery | IPC2 | Ischaemia and reperfusion time (min)3 | Parameters assessed | Outcome of IPC |
| Clavien et al[17] (2000) | 24 (12) | Liver resection | 10I + 10R | IPC and control (TI: 30) | PT, Bilirubin, ALT, AST, Histology, Caspase-3 and 8 activity, SEC apoptosis, Blood loss, Transfusion, ITU stay, LOS | Protective against IRI Beneficial in patients with steatosis |
| Clavien et al[204] (2003) | 100 (50) | Liver resection | 10I + 10R | IPC (TI: 36 ± 5.9, Op: 225 ± 73), Control (TI: 35 ± 6.8, Op: 240 ± 92) | PT, Bilirubin, ALT, AST, Histology, Hepatic ATP, Blood loss, Transfusion, ITU stay, LOS | Protective against IRI Beneficial in younger patients, those with steatosis and longer periods of occlusion |
| Li et al[205] (2004) | 29 (14) | Liver resection | 5I + 5R | IPC (TI: 18 ± 3.6, Op: 191.3 ± 74.9), Control (TI: 17.4 ± 2.3, Op: 208.2 ± 45.3) | Bilirubin, ALT, AST, Histology, Caspase-3 activity, SEC apoptosis, LOS | Protective against IRI, mainly HCC patients with cirrhosis Shorter hospital stay |
| Nuzzo et al[209] (2004) | 42 (21) | Liver resection | 10I + 10R | IPC (TI: 54 ± 19, Op: 321 ± 92), Control (TI: 36 ± 14, Op: 339 ± 112) | PT, Bilirubin, ALT, AST, Transfusion, Morbidity, Mortality | Reduces operative bleeding Protective against IRI |
| Chouker et al[206] (2004) | 68 (22) | Liver resection | 10I + 10R | IPC (TI: 32 ± 6.3, Op: 251 ± 46), Control without PR (TI: NA, Op: 52 ± 30), Control with PR (TI: 35 ± 11, Op: 257 ± 83) | ALT, AST, Fluid loss, Transfusion, 4Cardiovascular status | Protective against IRI Improves haemodynamic stability |
| Chouker et al[207] (2005) | 75 (25) | Liver resection | 10I + 10R | IPC (TI: 35.5 ± 2.7, LR: 32.2 ± 2.0), Control without PR (TI: NA, LR: 39 ± 4.5), Control with PR (TI: 35.6 ± 2.6, LR: 33.2 ± 2.3) | IL-6, IL-8, Cytochrome c, Adhesion molecules [B2-integrins (CD18)], Histology (neutrophil infiltration) | Protective against IRI by attenuating neutrophil activation and IL-8 release |
| Chouker et al[208] (2005) | 73 (25) | Liver resection | 10I + 10R | IPC (TI: 35.12 ± 13.6, LR: 31.50 ± 9.1), Control without PR (TI: NA, LR: 34.77 ± 16.5), Control with PR (TI: 34.2 ± 10.9, LR: 32.13 ± 10) | PT, ALT, AST, α-GST | Protective against IRI Prevented early rise of α-GST |
| Koneru et al[210] (2005) | 62 (34) | Transplant | 5I + 5R | IPC (CI: 384 ± 92, WI: 41 ± 5.8), Control (CI: 415 ± 87, WI: 37 ± 5.6) | INR, Bilirubin, ALT, AST, Histology (apoptosis, hepatocyte swelling), LOS, Survival (6 mo) | No beneficial effect |
| Azoulay et al[212] (2005) | 91 (46) | Transplant | 10I + 10R | IPC (CI: 436 ± 116, Op: 441 ± 119), Control (CI: 461 ± 96, Op: 462 ± 98) | PT, Bilirubin, ALT, AST, Histology, Graft function, Morbidity, Mortality | Better ischaemic tolerance Decreased early graft function |
| Jassem et al[211] (2005) | 23 (9) | Transplant | 10I + 10R | IPC (CI: 620 ± 190, WI: 43.9 ± 13), Control (CI: 665 ± 280, WI: 40.4 ± 9) | AST, INR, Lactate, ITU stay, Histology (neutrophil infiltration, platelet deposition), Graft function | Protective against IRI Reduces inflammatory response Shorter ITU stay |
| Cescon et al[213] (2006) | 47 (23) | Transplant | 10I + 15R | 5IPC [TI: 388 (259-830), Op: 440 (225-725)], Control [TI: 383 (279-695), Op: 465 (280-1015)] | PT, Bilirubin, ALT, AST, Histology (neutrophil, lymphocyte infiltration, iNOS, apoptosis), Graft function, Survival (1 yr) | Protective against IRI No clinical benefit |
Patients stated in brackets are the number of patients who had ischaemic preconditioning treatment;
IPC was performed by portal triad clamping in all these studies;
Ischaemia and operative times are presented as mean ± SD unless otherwise stated;
Cardiovascular status refers to mean arterial pressure, central venous pressure, heart rate, stroke volume index, systemic vascular resistance index, fluid infusion and catecholamines requirements;
Ischaemia and reperfusion times in this study were presented as median (range). I: Ischaemia; R: Reperfusion; IPC: Ischaemic preconditioning group; PR: Pringle maneuver; TI: Total ischaemia time; CI: Cold ischaemia time; WI: Warm ischaemia time; Op: Total operative time; LR: Liver resection time; ITU: Intensive therapy unit; LOS: Length of hospital stay; PT: Pro-thrombin time; INR: International normalized ratio of pro-thrombin time; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; α-GST: Alpha-Gluthathione S-Transferase; iNOS: Inducible form of nitric oxide synthase; ATP: Adenosine triphosphate; HCC: Hepatocellular carcinoma; IL: Interleukin; SEC: Sinusoidal endothelial cell; IRI: Ischaemia-reperfusion injury.