Outcomes and mechanisms of ischemic preconditioning in liver transplantation.
BACKGROUND
Liver transplantation is so far the most effective therapeutic modality for end-stage liver diseases, but ischemia/reperfusion (I/R) injury represents a critical barrier to liver transplantation. Primary graft dysfunction and small-for-size syndrome are closely associated with I/R injury. Ischemic preconditioning (IPC) is defined as a brief period of liver ischemia followed by reperfusion, and has demonstrated protections against a prolonged I/R injury and improved the capacity of regeneration. The article aimed to review IPC literatures for the understanding of the effects of IPC on I/R injury involving in the procurement of donor liver and protective mechanisms.


METHODS
A literature search of MEDLINE and Web of Science databases using "liver transplantation", "liver regeneration", "hepatectomy", "ischemia/reperfusion" and "ischemic preconditioning" was performed, and then a large amount of related data was collected.


RESULTS
The literature search provided a huge amount of evidence for the protective effects of IPC on I/R injury in liver transplantation, including reduction of blood loss in hepatectomy, intraoperative hemodynamic stability and its significant role in liver regeneration. The mechanism involves in balancing inflammatory cytokines, enhancing energy status and mitigating microcirculatory disturbance.


CONCLUSIONS
IPC plays an essential role in hepatectomy before and after harvest of living donor liver and implantation of liver graft.
Yan
Sheng
S
First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Jin
Li-Ming
LM
Liu
Yuan-Xing
YX
Zhou
Lin
L
Xie
Hai-Yang
HY
Zheng
Shu-Sen
SS
D006801:Humans; D019194:Ischemic Preconditioning; D008107:Liver Diseases / Q000601:surgery*; D016031:Liver Transplantation; D019520:Living Donors; D011379:Prognosis; D015427:Reperfusion Injury / Q000517:prevention & control; D016896:Treatment Outcome