Ischemic preconditioning protects liver from hepatectomy under hepatic inflow occlusion for hepatocellular carcinoma patients with cirrhosis.
OBJECTIVE
To investigate the protective effect of ischemic preconditioning (IPC) on hepatocellular carcinoma (HCC) patients with cirrhosis undergoing hepatic resection under hepatic inflow occlusion (HIO) and its possible mechanism.


METHODS
Twenty-nine consecutive patients with resectable 0HCC were randomized into two groups: IPC group: before HIO, IPC with 5 min of ischemia and 5 min of reperfusion was given; control group: no IPC was given. Liver functions, hepatic Caspase-3 activity, and apoptotic cells were compared between these two groups.


RESULTS
On postoperative days (POD) 1, 3 and 7, the aspartate transaminase (AST) and alanine transaminase (ALT) levels in the IPC group were significantly lower than those in the control group (P<0.05). On POD 3 and 7, the total bilirubin level in the IPC group was significantly lower than that in the control group (P<0.05). On POD 1, the albumin level in the IPC group was higher than that in the control group (P = 0.053). After 1 h of reperfusion, both hepatic Caspase-3 activity and apoptotic sinusoidal endothelial cells in the IPC group were significantly lower than those in the control group (P<0.05).


CONCLUSIONS
IPC has a potential protective effect on HCC patients with cirrhosis. Its protective mechanism underlying the suppression of sinusoidal endothelial cell apoptosis is achieved by inhibiting Caspase-3 activity.
Li
Shao-Qiang
SQ
Department of Hepatobiliary Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China.
Liang
Li-Jian
LJ
Huang
Jie-Fu
JF
Li
Zhi
Z
D000328:Adult; D017209:Apoptosis; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D053148:Caspase 3; D020169:Caspases / Q000378:metabolism; D005260:Female; D006498:Hepatectomy / Q000379:methods* / Q000401:mortality; D006801:Humans; D019194:Ischemic Preconditioning; D007902:Length of Stay; D008099:Liver / Q000473:pathology / Q000601:surgery; D008103:Liver Cirrhosis / Q000401:mortality / Q000473:pathology / Q000601:surgery; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000473:pathology / Q000517:prevention & control; D011446:Prospective Studies; D015427:Reperfusion Injury / Q000401:mortality / Q000473:pathology / Q000517:prevention & control*
C505407:CASP3 protein, human; D053148:Caspase 3; D020169:Caspases