title: Ischemic preconditioning-induced hyperperfusion correlates with hepatoprotection after liver resection.
abstract: OBJECTIVE
  To characterize the impact of the Pringle maneuver (PM) and ischemic preconditioning (IP) on total blood supply to the liver following hepatectomies.
  
  
  METHODS
  Sixty one consecutive patients who underwent hepatic resection under inflow occlusion were randomized either to receive PM alone (n = 31) or IP (10 min of ischemia followed by 10 min of reperfusion) prior to PM (n = 30). Quantification of liver perfusion was measured by Doppler probes at the hepatic artery and portal vein at various time points after reperfusion of remnant livers.
  
  
  RESULTS
  Occlusion times of 33 +/- 12 min (mean +/- SD) and 34 +/- 14 min and the extent of resected liver tissue (2.7 segments) were similar in both groups. In controls (PM), on reperfusion of liver remnants for 15 min, portal perfusion markedly decreased by 29% while there was a slight increase of 8% in the arterial blood flow. In contrast, following IP + PM the portal vein flow remained unchanged during reperfusion and a significantly increased arterial blood flow (+56% vs baseline) was observed. In accordance with a better postischemic blood supply of the liver, hepatocellular injury, as measured by alanine aminotransferase (ALT) levels on day 1 was considerably lower in group B compared to group A (247 +/- 210 U/I vs 550 +/- 650 U/I, P < 0.05). Additionally, ALT levels were significantly correlated to the hepatic artery inflow.
  
  
  CONCLUSIONS
  IP prevents postischemic flow reduction of the portal vein and simultaneously increases arterial perfusion, suggesting that improved hepatic macrocirculation is a protective mechanism following hepatectomy.
authors.affiliation: Department of Surgery, University Hospital Basel, CH-4031 Basel, Switzerland. oheizmann@uhbs.ch
authors.forename: Oleg
authors.initials: O
authors.lastname: Heizmann
authors.forename: Georgios
authors.initials: G
authors.lastname: Meimarakis
authors.forename: Andreas
authors.initials: A
authors.lastname: Volk
authors.forename: Daniel
authors.initials: D
authors.lastname: Matz
authors.forename: Daniel
authors.initials: D
authors.lastname: Oertli
authors.forename: Rolf J
authors.initials: RJ
authors.lastname: Schauer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000473:pathology; D005260:Female; D006801:Humans; D019194:Ischemic Preconditioning / Q000379:methods*; D008099:Liver / Q000473:pathology* / Q000601:surgery*; D008107:Liver Diseases / Q000601:surgery; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D010477:Perfusion; D016016:Proportional Hazards Models; D013997:Time Factors
references.citation: Shock. 1994 Jan;1(1):3-9
references.pmid: 7743324
references.citation: J Hepatobiliary Pancreat Surg. 1998;5(4):402-8
references.pmid: 9931389
references.citation: Am J Physiol. 1991 Mar;260(3 Pt 1):G355-62
references.pmid: 2003603
references.citation: Ann Surg. 2004 Feb;239(2):220-31
references.pmid: 14745330
references.citation: Br J Surg. 1993 Sep;80(9):1161-5
references.pmid: 8402122
references.citation: Transplantation. 2001 Nov 27;72(10):1692-9
references.pmid: 11726835
references.citation: Ann Surg. 1999 Mar;229(3):369-75
references.pmid: 10077049
references.citation: Intensive Care Med. 1994 Jul;20(6):414-20
references.pmid: 7798445
references.citation: Transplantation. 1993 Apr;55(4):807-13
references.pmid: 8475556
references.citation: Ann Surg. 2003 Dec;238(6):843-50; discussion 851-2
references.pmid: 14631221
references.citation: Am J Pathol. 1994 Dec;145(6):1421-31
references.pmid: 7992845
references.citation: Br J Surg. 1992 Jan;79(1):39-42
references.pmid: 1346582
references.citation: Circulation. 1986 Nov;74(5):1124-36
references.pmid: 3769170
references.citation: Eur Surg Res. 2005 May-Jun;37(3):144-52
references.pmid: 16088179
references.citation: Ann Surg. 1999 Mar;229(3):376-84
references.pmid: 10077050
references.citation: Br J Surg. 2004 Oct;91(10):1330-9
references.pmid: 15376207
references.citation: Br J Surg. 1995 Sep;82(9):1262-5
references.pmid: 7552014
references.citation: Br J Anaesth. 1996 Jul;77(1):50-8
references.pmid: 8703630
references.citation: Transplantation. 1998 Jan 15;65(1):68-72
references.pmid: 9448146
references.citation: Ann Surg. 2000 Aug;232(2):155-62
references.pmid: 10903590
references.citation: Hepatology. 2003 Feb;37(2):286-95
references.pmid: 12540778
references.citation: Ann Surg. 1908 Oct;48(4):541-9
references.pmid: 17862242
references.citation: Anesth Analg. 2002 Jun;94(6):1448-57
references.pmid: 12032004
references.citation: Hepatology. 1999 Nov;30(5):1223-31
references.pmid: 10534344
references.citation: J Hepatol. 2003 Jan;38(1):59-66
references.pmid: 12480561
references.citation: Am J Surg. 2006 Nov;192(5):669-74
references.pmid: 17071204
references.citation: Transplant Proc. 1997 Feb-Mar;29(1-2):362-3
references.pmid: 9123038
references.citation: J Hepatol. 2000 Mar;32(3):508-15
references.pmid: 10735623
references.citation: Liver Transpl. 2005 May;11(5):555-63
references.pmid: 15838880
references.citation: Eur J Med Res. 2008 Feb 25;13(2):79-86
references.pmid: 18424367
references.citation: Am J Physiol. 1987 Apr;252(4 Pt 2):H836-45
references.pmid: 3565595
references.citation: Br J Anaesth. 2004 Aug;93(2):204-11
references.pmid: 15194628
references.citation: Ann Surg. 2006 Dec;244(6):921-8; discussion 928-30
references.pmid: 17122617
references.citation: Ann Intern Med. 2001 Apr 17;134(8):657-62
references.pmid: 11304106
references.citation: Semin Liver Dis. 1999;19(4):383-96
references.pmid: 10643624
references.citation: J Hepatol. 2001 Feb;34(2):278-83
references.pmid: 11281557
references.citation: Surgery. 1996 Nov;120(5):852-8
references.pmid: 8909521
references.citation: Am J Physiol. 1985 Nov;249(5 Pt 1):G549-56
references.pmid: 3904482
references.citation: Cancer. 1993 Sep 15;72(6):1866-71
references.pmid: 8395966
references.citation: Am J Surg Pathol. 2006 Aug;30(8):986-93
references.pmid: 16861970
references.citation: Hepatology. 2000 Aug;32(2):169-73
references.pmid: 10915720