Prospective randomized study of the benefits of preoperative corticosteroid administration on hepatic ischemia-reperfusion injury and cytokine response in patients undergoing hepatic resection.
BACKGROUND
Hepatic injury secondary to warm ischemia and reperfusion (I/R) remains an important clinical issue following liver surgery. The aim of this prospective, randomized study was to determine whether steroid administration may reduce liver injury and improve short-term outcome.


METHODS
Forty-three patients undergoing liver resection were randomized to a steroid group or a control group. Patients in the steroid group received 500 mg of methylprednisolone preoperatively. Serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, anti-thrombin III (AT-III), prothrombin time (PT), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-alpha) were compared between the two groups. Length of stay and type and number of complications were recorded.


RESULTS
Postoperative serum levels of ALT, AST, total bilirubin, and inflammatory cytokines were significantly lower in the steroid group than in controls. The postoperative level of AT-III in the control group was significantly lower than in the steroid group (ANOVA p < 0.01). The incidence of postoperative complications in the control group tended to be significantly higher than that in the steroid group.


CONCLUSIONS
These results suggest that steroid pretreatment represents a potentially important biologic modifier of I/R injury and may contribute to maintenance of coagulant/anticoagulant homeostasis.
Pulitanò
Carlo
C
Department of Surgery-Liver Unit, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy. pulitano.carlo@hsr.it
Aldrighetti
Luca
L
Arru
Marcella
M
Finazzi
Renato
R
Soldini
Laura
L
Catena
Marco
M
Ferla
Gianfranco
G