Hepatic ischaemia-reperfusion injury from bench to bedside.
BACKGROUND
Vascular occlusion to prevent haemorrhage during liver resection causes ischaemia-reperfusion (IR) injury. Insights into the mechanisms of IR injury gathered from experimental models have contributed to the development of therapeutic approaches, some of which have already been tested in randomized clinical trials.


METHODS
The review was based on a PubMed search using the terms 'ischemia AND hepatectomy', 'ischemia AND liver', 'hepatectomy AND drug treatment', 'liver AND intermittent clamping' and 'liver AND ischemic preconditioning'; only randomized controlled trials (RCTs) were included.


RESULTS
Twelve RCTs reported on ischaemic preconditioning and intermittent clamping. Both strategies seem to confer protection and allow extension of ischaemia time. Fourteen RCTs evaluating pharmacological interventions, including antioxidants, anti-inflammatory drugs, vasodilators, pharmacological preconditioning and glucose infusion, were identified.


CONCLUSIONS
Several strategies to prevent hepatic IR have been developed, but few have been incorporated into clinical practice. Although some pharmacological strategies showed promising results with improved clinical outcome there is not sufficient evidence to recommend them.
Bahde
R
R
Surgical Research, Department of General and Visceral Surgery, Muenster University Hospital, Waldeyer Strasse 1, D-48149 Muenster, Germany.
Spiegel
H-U
HU
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000975:Antioxidants / Q000627:therapeutic use; D005947:Glucose / Q000008:administration & dosage; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D007262:Infusions, Intravenous; D019194:Ischemic Preconditioning / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D015427:Reperfusion Injury / Q000517:prevention & control*; D014665:Vasodilator Agents / Q000627:therapeutic use
D000893:Anti-Inflammatory Agents; D000975:Antioxidants; D014665:Vasodilator Agents; D005947:Glucose