Ischaemic preconditioning in transplantation and major resection of the liver.
BACKGROUND
Ischaemia-reperfusion injury (IRI) contributes significantly to the morbidity and mortality of transplantation and major resection of the liver. Its severity is reduced by ischaemic preconditioning (IP), the precise mechanisms of which are not completely understood. This review discusses the pathophysiology and role of IP in this clinical setting.


METHODS
A Medline search was performed using the keywords 'ischaemic preconditioning', 'ischaemia-reperfusion injury', 'transplantation' and 'hepatic resection'. Additional articles were obtained from references within the papers identified by the Medline search.


CONCLUSIONS
The mechanisms underlying hepatic IRI are complex, but IP reduces the severity of such injury in several animal models and in recent human trials. Increased understanding of the cellular processes involved in IP is of importance in the development of treatment strategies aimed at improving outcome after liver transplantation and major hepatic resection.
Banga
N R
NR
Department of Hepatobiliary Surgery and Transplantation, St James's University Hospital, Leeds, UK.
Homer-Vanniasinkam
S
S
Graham
A
A
Al-Mukhtar
A
A
White
S A
SA
Prasad
K R
KR
D000255:Adenosine Triphosphate / Q000378:metabolism; D015815:Cell Adhesion Molecules / Q000378:metabolism; D016923:Cell Death; D016207:Cytokines / Q000378:metabolism; D015870:Gene Expression; D006801:Humans; D019194:Ischemic Preconditioning / Q000379:methods*; D008099:Liver / Q000098:blood supply; D008107:Liver Diseases / Q000378:metabolism / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D008833:Microcirculation; D010770:Phosphotransferases / Q000378:metabolism; D015427:Reperfusion Injury / Q000378:metabolism / Q000517:prevention & control*
D015815:Cell Adhesion Molecules; D016207:Cytokines; D000255:Adenosine Triphosphate; D010770:Phosphotransferases