title: Protective effect of ischemic preconditioning against liver injury after major hepatectomy using the intermittent pringle maneuver in swine.
abstract: OBJECTIVE
  To investigate whether ischemic preconditioning (IP) protects the liver against ischemia-reperfusion injury (I/R-I) after major hepatectomy through intermittent hepatic pedicle clamping (IC) in a swine liver resection model.
  
  
  BACKGROUND
  Although many studies have reported a protective effect of IP against continuous hepatic ischemia, it has not been elucidated whether IP protects the liver against I/R-I after hepatectomy using IC. This is the first study to evaluate the effect of IP in a swine major hepatectomy model using IC.
  
  
  METHODS
  Pigs (n = 12) were divided into 2 groups (IP or non-IP). In the IP group, livers were subjected to IP (10 min ischemia and 10 min reperfusion) before liver resection using IC (15 min ischemia and 5 min reperfusion). A left hemihepatectomy was then performed using IC in both groups. Hemodynamic changes and plasma concentrations of aspartate aminotransferase, lactate dehydrogenase, lactic acid and hyaluronic acid were measured at 60, 120 and 180 min after hepatectomy. Apoptosis (TUNEL staining and electron microscopy), plasma tumor necrosis factor-alpha (TNF-alpha) and NO(2)(-)/NO(3)(-) were evaluated for 180 min after hepatectomy.
  
  
  RESULTS
  There were no significant differences in body weight, blood loss, resected liver weight, Pringle time or hemodynamic changes between the 2 groups. IP significantly reduced plasma aspartate aminotransferase levels for 180 min after hepatectomy (IP: 135.8 +/- 13.5 vs. non-IP: 199 +/- 16.8 IU/l; p = 0.018). In the non-IP group, apoptotic changes in sinusoidal endothelial cells were observed with increased plasma TNF-alpha levels. IP protected liver injury from increase in plasma TNF-alpha (p = 0.042). Significantly fewer apoptotic cells were seen in the IP than in the non-IP group (p = 0.002). Plasma levels of lactate dehydrogenase, lactic acid and NO(2)(-)/NO(3)(-) in the IP group tended to be lower than those in the non-IP group.
  
  
  CONCLUSIONS
  IP prior to hepatectomy with IC resulted in less hepatic injury and apoptotic cell death than in livers not subjected to IP. IP with IC has the potential to improve the clinical postoperative course of patients undergoing hepatectomy.
authors.affiliation: Department of Gastroenterological Surgery, Dokkyo University School of Medicine, Mibu, Japan. mshimoda@dokkyomed.ac.jp
authors.forename: Mitsugi
authors.initials: M
authors.lastname: Shimoda
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Iwasaki
authors.forename: Tokihiko
authors.initials: T
authors.lastname: Sawada
authors.forename: Keiichi
authors.initials: K
authors.lastname: Kubota
mesh_terms: D000818:Animals; D017209:Apoptosis; D013505:Digestive System Surgical Procedures / Q000379:methods; D006498:Hepatectomy; D020287:In Situ Nick-End Labeling; D019194:Ischemic Preconditioning; D008099:Liver / Q000601:surgery*; D008297:Male; D015427:Reperfusion Injury / Q000517:prevention & control*; D013552:Swine