Prospective Clinical Research Of Hepatic Ischemic Preconditioning

Objective: To evaluate the protective effects of ischemic preconditioning in a prospective randomized study of unselected patients and to identify factors affecting theprotective effects. Methods: A total of 48 unselected patients undergoing liver resection were prospectively randomized studied from Dec 2004 to Jun 2006. 48 unselected patients were randomized into two groups: IP group (5 minutes of ischemia followed by 5 minutes of reperfusion) and control group (received Pringle's maneuverno and no IP was given). Before inflow occlusion and 30min after reperfusion, a small piece of liver tissue was harvested by wedge resection in remnant liver. A part of liver tissue was conserved in -80℃refrigerator, another was embed with ozocerite. Postoperative days (POD) 1, 3 and 7, the aspartate transaminase (AST) and alanine transaminase (ALT) levels were checked. Postoperative mortality, morbidity and hospitalized days were compared. Fluorescence-activated cell sorting (FACS) analyzed the quantity and activity of Kupffer cells. Results: 47 patients were satisfactory with postoperative recovery, except a patients died with chronic liver dysfunction after 3 months postoperatively. In IP group, Ischemic times 5~80min, mean 31min. Extent hepatectmoy were 3 patients, right/left hepatectomy were 2 patients, segmentectomy were 19 patients. Hospitalized days were 13~50 days, mean 20 days. In control group, Ischemic times 10~60min, mean 27min.Extent hepatectmoy were 2 patients, right/left hepatectomy were 9 patients, segmentectomy were 13 patients. Hospitalized days were 10~33 days, mean 17 days. Postoperative days (POD) 1, 3 and 7, the aspartate transaminase (AST) and alanine transaminase (ALT) levels in two groups were not statistically significant. But in noncirrhosis of IP group POD 1, 3 ALT were lower statistically than control group. The number of Kupffer cells increase significantly on patients ischemic time >20min, but two groups were not statistically significant. Conclusion: The clinical use of IP through 5 minutes of warm ischemia in this technique of hepatectomy does not protect the liver from hepatic injury induced by the IRI process in liver cirrhosis. But IP should protect the liver from IRI in noncirrhosis , and it is worthy with studying.