Systematic review of randomized controlled trials of pharmacological interventions to reduce ischaemia-reperfusion injury in elective liver resection with vascular occlusion.
BACKGROUND
Vascular occlusion during liver resection results in ischaemia-reperfusion (IR) injury, which can lead to liver dysfunction. We performed a systematic review and meta-analysis to assess the benefits and harms of using various pharmacological agents to decrease IR injury during liver resection with vascular occlusion.


METHODS
Randomized clinical trials (RCTs) evaluating pharmacological agents in liver resections conducted under vascular occlusion were identified. Two independent reviewers extracted data on population characteristics and risk of bias in the trials, and on outcomes such as postoperative morbidity, hospital stay and liver function.


RESULTS
A total of 18 RCTs evaluating 17 different pharmacological interventions were identified. There was no significant difference in perioperative mortality, liver failure or postoperative morbidity between the intervention and control groups in any of the comparisons. A significant improvement in liver function was seen with methylprednisolone use. Hospital and intensive therapy unit stay were significantly shortened with trimetazidine and vitamin E use, respectively. Markers of liver parenchymal injury were significantly lower in the methylprednisolone, trimetazidine, dextrose and ulinastatin groups compared with their respective controls (placebo or no intervention).


CONCLUSIONS
Methylprednisolone, trimetazidine, dextrose and ulinastatin may have protective roles against IR injury in liver resection. However, based on the current evidence, they cannot be recommended for routine use and their application should be restricted to RCTs.
Abu-Amara
Mahmoud
M
Hepatopancreatobiliary and Liver Transplant Surgery, University Department of Surgery, Royal Free and University College School of Medicine, Royal Free Hospital Campus, London, UK. m_abu_amara@hotmail.com
Gurusamy
Kurinchi
K
Hori
Satoshi
S
Glantzounis
George
G
Fuller
Barry
B
Davidson
Brian R
BR
D015415:Biomarkers / Q000097:blood; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D003250:Constriction; D017558:Elective Surgical Procedures; D019317:Evidence-Based Medicine; D006498:Hepatectomy / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D007902:Length of Stay; D017093:Liver Failure / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D018579:Patient Selection; D020011:Protective Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D015427:Reperfusion Injury / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D020011:Protective Agents