Ischemic preconditioning for major liver resection under vascular exclusion of the liver preserving the caval flow: A randomized prospective study

Daniel Azoulay, Valério Lucidi, Paola Andreani, Umberto Maggi, Mylène Sebagh, Philippe Ichai, Antoinette Lemoine, René Adam, Denis Castaing

Research output: Contribution to journalArticle

73 Citations (Scopus)

Abstract

BACKGROUND: Two randomized prospective studies suggested that ischemic preconditioning (IP) protects the human liver against ischemia-reperfusion injury after hepatectomy performed under continuous clamping of the portal triad. The primary goal of this study was to determine whether IP protects the human liver against ischemia-reperfusion injury after hepatectomy under continuous vascular exclusion with preservation of the caval flow. STUDY DESIGN: Sixty patients were randomly divided into two groups: with (n = 30; preconditioning group) and without (n = 30; control group) IP (10 minutes of portal triad clamping and 10 minutes of reperfusion) before major hepatectomy under vascular exclusion of the liver preserving the caval flow. Serum concentrations of aspartate transferase, alanine transferase, glutathione-S-transferase, and bilirubin and prothrombin time were regularly determined until discharge and at 1 month. Morbidity and mortality were determined in both groups. RESULTS: Peak postoperative concentrations of aspartate transferase were similar in the groups with and without IP (851 ± 1,733 IU/L and 427 ± 166 IU/L respectively, p = 0.2). A similar trend toward a higher peak concentration of alanine transferase and glutathione-S-transferase was indeed observed in the preconditioning group compared with the control group. Morbidity and mortality rates and lengths of ICU and hospitalization stays were similar in both groups. CONCLUSIONS: IP does not improve liver tolerance to ischemia-reperfusion after hepatectomy under vascular exclusion of the liver with preservation of the caval flow. This maneuver does not improve postoperative liver function and does not affect morbidity or mortality rates. The clinical use of IP through 10 minutes of warm ischemia in this technique of hepatectomy is not currently recommended.

Original languageEnglish
Pages (from-to)203-211
Number of pages9
JournalJournal of the American College of Surgeons
Volume202
Issue number2
DOIs
Publication statusPublished - Feb 2006

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Ischemic Preconditioning
Venae Cavae
Hepatectomy
Blood Vessels
Prospective Studies
Transferases
Liver
Glutathione Transferase
Reperfusion Injury
Morbidity
Aspartic Acid
Constriction
Alanine
Reperfusion
Mortality
Warm Ischemia
Control Groups
Prothrombin Time
Bilirubin
Hospitalization

ASJC Scopus subject areas

  • Surgery

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Ischemic preconditioning for major liver resection under vascular exclusion of the liver preserving the caval flow : A randomized prospective study. / Azoulay, Daniel; Lucidi, Valério; Andreani, Paola; Maggi, Umberto; Sebagh, Mylène; Ichai, Philippe; Lemoine, Antoinette; Adam, René; Castaing, Denis.

In: Journal of the American College of Surgeons, Vol. 202, No. 2, 02.2006, p. 203-211.

Research output: Contribution to journalArticle

Azoulay, Daniel ; Lucidi, Valério ; Andreani, Paola ; Maggi, Umberto ; Sebagh, Mylène ; Ichai, Philippe ; Lemoine, Antoinette ; Adam, René ; Castaing, Denis. / Ischemic preconditioning for major liver resection under vascular exclusion of the liver preserving the caval flow : A randomized prospective study. In: Journal of the American College of Surgeons. 2006 ; Vol. 202, No. 2. pp. 203-211.
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AU - Andreani, Paola

AU - Maggi, Umberto

AU - Sebagh, Mylène

AU - Ichai, Philippe

AU - Lemoine, Antoinette

AU - Adam, René

AU - Castaing, Denis

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N2 - BACKGROUND: Two randomized prospective studies suggested that ischemic preconditioning (IP) protects the human liver against ischemia-reperfusion injury after hepatectomy performed under continuous clamping of the portal triad. The primary goal of this study was to determine whether IP protects the human liver against ischemia-reperfusion injury after hepatectomy under continuous vascular exclusion with preservation of the caval flow. STUDY DESIGN: Sixty patients were randomly divided into two groups: with (n = 30; preconditioning group) and without (n = 30; control group) IP (10 minutes of portal triad clamping and 10 minutes of reperfusion) before major hepatectomy under vascular exclusion of the liver preserving the caval flow. Serum concentrations of aspartate transferase, alanine transferase, glutathione-S-transferase, and bilirubin and prothrombin time were regularly determined until discharge and at 1 month. Morbidity and mortality were determined in both groups. RESULTS: Peak postoperative concentrations of aspartate transferase were similar in the groups with and without IP (851 ± 1,733 IU/L and 427 ± 166 IU/L respectively, p = 0.2). A similar trend toward a higher peak concentration of alanine transferase and glutathione-S-transferase was indeed observed in the preconditioning group compared with the control group. Morbidity and mortality rates and lengths of ICU and hospitalization stays were similar in both groups. CONCLUSIONS: IP does not improve liver tolerance to ischemia-reperfusion after hepatectomy under vascular exclusion of the liver with preservation of the caval flow. This maneuver does not improve postoperative liver function and does not affect morbidity or mortality rates. The clinical use of IP through 10 minutes of warm ischemia in this technique of hepatectomy is not currently recommended.

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