Advantage of ischemic preconditioning for hepatic resection in pigs.
BACKGROUND
Ischemic preconditioning (IP) and intermittent inflow occlusion (IO) have provided beneficial outcomes in hepatic resection. However, comparison of these two procedures against warm hepatic ischemia-reperfusion injury has not been studied enough.


METHODS
Pigs that had undergone 65% hepatectomy were subjected to Control (120 min continuous ischemia, n = 6), IP (10 min ischemia and 10 min reperfusion, followed by 120 min continuous ischemia, n = 6), and IO (120 min ischemia in the form of eight successive periods of 15 min ischemia and 5 min reperfusion, n = 6). We evaluated hepatocyte injury by aspartate aminotransferase, lactate dehydrogenase and hepaplastin test, hepatic microcirculation by hepatic tissue blood flow (HTBF) and endothelin (ET)-1, inflammatory response by tumor necrosis factor-alpha (TNF-alpha), and histopathology after reperfusion.


RESULTS
IP prevented hepatocyte injury, HTBF disturbance, and hepatocyte necrosis in histopathology as well as IO. These two groups showed significantly better outcomes than Control. IP produced significantly less ET-1 and TNF-alpha than IO.


CONCLUSIONS
IP ameliorated hepatic warm ischemia-reperfusion injury. Furthermore, IP gained more advantages in preventing chemokine production such as ET-1 and inflammatory response over IO. IP could take the place of IO for hepatectomy.
Kadono
Jun
J
Second Department of Surgery, Faculty of Medicine, Kagoshima University, Sakuragaoka, Kagoshima, Japan. kadonofamily@k6.dion.ne.jp
Hamada
Nobuo
N
Fukueda
Mikio
M
Ishizaki
Naoki
N
Kaieda
Mamoru
M
Gejima
Kentaro
K
Nishida
Seigo
S
Nakamura
Kazuo
K
Yoshida
Hiroki
H
Sakata
Ryuzo
R
D000818:Animals; D001219:Aspartate Aminotransferases / Q000097:blood; D001783:Blood Flow Velocity; D019332:Endothelin-1 / Q000097:blood; D006498:Hepatectomy / Q000379:methods; D007249:Inflammation / Q000473:pathology; D019194:Ischemic Preconditioning; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008099:Liver / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D008297:Male; D008833:Microcirculation; D009336:Necrosis; D011183:Postoperative Complications; D015427:Reperfusion Injury / Q000473:pathology / Q000517:prevention & control; D013047:Specific Pathogen-Free Organisms; D013552:Swine; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D019332:Endothelin-1; D014409:Tumor Necrosis Factor-alpha; D007770:L-Lactate Dehydrogenase; D001219:Aspartate Aminotransferases