Antioxidant treatment during liver resection for alleviation of ischemia-reperfusion injury.
OBJECTIVE
Many experimental studies on ischemia-reperfusion injury in animals suggest a preventive effect of antioxidants, but the clinical significance of these findings is still unclear. The aim of our study was to evaluate the effect of antioxidant treatment with vitamins on liver function parameters during liver resection.


METHODS
Our prospective randomized study comprised 58 patients undergoing major liver surgery, including the Pringle maneuver. In the treatment group 32 patients received a multivitamin infusion (Omnibionta) which included 10 mg of alpha-tocopherol acetate, 2 mg of DL-alpha-tocopherol and 1 g of ascorbate. The control group consisted of 26 patients. Various parameters associated with liver function, such as transaminases, lactate, ammonia, bilirubin, cholinesterase and clotting parameters were measured preoperatively, at the beginning of liver ischemia, 15, 30 and 60 minutes after reperfusion onset and every 12 hours after the operation.


RESULTS
The Mann-Whitney-Wilcoxon-Test showed statistically significant differences in the postischemic changes between the treatment group and the control group for the Quick test (prothrombin time): p = 0.01. The transaminases were also markedly better in the treatment group (splitting-up slightly more delayed than with the Quick test). A smaller effect was seen with cholinesterase. Lactate, however, increased intraoperatively with a strong correlation to the duration of ischemia and returned quickly to baseline values without any remarkable influence of the antioxidant treatment.


CONCLUSIONS
In our study, antioxidant treatment with a multivitamin infusion showed a positive effect on postischemic liver function parameters.
Department of General Surgery, Karl-Franzens University School of Medicine, Graz, Austria. cerwenka@kfunigraz.ac.at
H
H
Cerwenka
H
H
Bacher
G
G
Werkgartner
A
A
El-Shabrawi
F
F
Quehenberger
H
H
Hauser
H J
HJ
Mischinger
D000410:Alanine Transaminase / Q000378:metabolism; D000975:Antioxidants / Q000627:therapeutic use*; D001219:Aspartate Aminotransferases / Q000378:metabolism; D002802:Cholinesterases / Q000378:metabolism; D005069:Evaluation Studies as Topic; D006801:Humans; D019344:Lactic Acid / Q000378:metabolism; D008099:Liver / Q000187:drug effects / Q000201:enzymology / Q000601:surgery; D008111:Liver Function Tests; D011446:Prospective Studies; D011517:Prothrombin Time; D015427:Reperfusion Injury / Q000188:drug therapy*; D013997:Time Factors; D014815:Vitamins / Q000627:therapeutic use*
D000975:Antioxidants; D014815:Vitamins; D019344:Lactic Acid; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D002802:Cholinesterases