Brief Article
Copyright ©2010 Baishideng. All rights reserved
World J Gastroenterol. Apr 21, 2010; 16(15): 1871-1878
Published online Apr 21, 2010. doi: 10.3748/wjg.v16.i15.1871
Ischemic preconditioning-induced hyperperfusion correlates with hepatoprotection after liver resection
Oleg Heizmann, Georgios Meimarakis, Andreas Volk, Daniel Matz, Daniel Oertli, Rolf J Schauer
Oleg Heizmann, Daniel Matz, Daniel Oertli, Department of Surgery, University Hospital Basel, CH-4031 Basel, Switzerland
Oleg Heizmann, Georgios Meimarakis, Andreas Volk, Rolf J Schauer, Department of Surgery, Klinikum of the Ludwig-Maximilians-University-Grosshadern, University of Munich, 81377 Munich, Germany
Andreas Volk, Department of Surgery, University Hospital of Dresden, 01304 Dresden, Germany
Rolf J Schauer, Department of Surgery, Academic Hospital of the Ludwig-Maximilians-University of Munich, 83278 Traunstein, Germany
Author contributions: Heizmann O designed the study and supervised the data collection; Volk A collected all the data during surgery; Meimarakis G and Matz D analyzed all the data; Schauer RJ wrote the manuscript, provided financial support for this work and performed liver resections; Oertli D approved the final manuscript.
Supported by The Deutsche Forschungsgemeinschaft, No. DFG SCHA 857/1-1
Correspondence to: Oleg Heizmann, MD, Department of Surgery, University Hospital Basel, CH-4031 Basel, Switzerland. oheizmann@uhbs.ch
Telephone: +41-61-2657250 Fax: +41-61-2652525
Received: December 25, 2009
Revised: January 21, 2010
Accepted: January 28, 2010
Published online: April 21, 2010
Abstract

AIM: To characterize the impact of the Pringle maneuver (PM) and ischemic preconditioning (IP) on total blood supply to the liver following hepatectomies.

METHODS: Sixty one consecutive patients who underwent hepatic resection under inflow occlusion were randomized either to receive PM alone (n = 31) or IP (10 min of ischemia followed by 10 min of reperfusion) prior to PM (n = 30). Quantification of liver perfusion was measured by Doppler probes at the hepatic artery and portal vein at various time points after reperfusion of remnant livers.

RESULTS: Occlusion times of 33 ± 12 min (mean ± SD) and 34 ± 14 min and the extent of resected liver tissue (2.7 segments) were similar in both groups. In controls (PM), on reperfusion of liver remnants for 15 min, portal perfusion markedly decreased by 29% while there was a slight increase of 8% in the arterial blood flow. In contrast, following IP + PM the portal vein flow remained unchanged during reperfusion and a significantly increased arterial blood flow (+56% vs baseline) was observed. In accordance with a better postischemic blood supply of the liver, hepatocellular injury, as measured by alanine aminotransferase (ALT) levels on day 1 was considerably lower in group B compared to group A (247 ± 210 U/I vs 550 ± 650 U/I, P < 0.05). Additionally, ALT levels were significantly correlated to the hepatic artery inflow.

CONCLUSION: IP prevents postischemic flow reduction of the portal vein and simultaneously increases arterial perfusion, suggesting that improved hepatic macrocirculation is a protective mechanism following hepatectomy.

Keywords: Ischemic preconditioning; Reperfusion injury; Liver; Surgery; Liver blood flow