Ischemia–reperfusion injury in patients with fatty liver   and the clinical impact of steatotic liver on hepatic surgery.
Hepatic steatosis is one of the most common hepatic disorders in developed countries. The epidemic of obesity in developed countries has increased with its attendant complications, including metabolic syndrome and non-alcoholic fatty liver disease. Steatotic livers are particularly vulnerable to ischemia/reperfusion injury, resulting in an increased risk of postoperative morbidity and mortality after liver surgery, including liver transplantation. There is growing understanding of the molecular and cellular mechanisms and therapeutic approaches for treating ischemia/reperfusion injury in patients with steatotic livers. This review discusses the mechanisms underlying the susceptibility of steatotic livers to ischemia/reperfusion injuries, such as mitochondrial dysfunction and signal transduction alterations, and summarizes the clinical impact of steatotic livers in the setting of hepatic resection and liver transplantation. This review also describes potential therapeutic approaches, such as ischemic and pharmacological preconditioning, to prevent ischemia/reperfusion injury in patients with steatotic livers. Other approaches, including machine perfusion, are also under clinical investigation; however, many pharmacological approaches developed through basic research are not yet suitable for clinical application.
Hirotaka
H
Tashiro
Shintaro
S
Kuroda
Yoshihiro
Y
Mikuriya
Hideki
H
Ohdan
D004198:Disease Susceptibility; D005234:Fatty Liver / Q000209:etiology*; D006498:Hepatectomy; D006801:Humans; D016031:Liver Transplantation; D024821:Metabolic Syndrome / Q000150:complications; D028361:Mitochondrial Diseases / Q000209:etiology; D009017:Morbidity; D009765:Obesity / Q000150:complications; D047492:Peroxisome Proliferator-Activated Receptors / Q000502:physiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D015427:Reperfusion Injury / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D012306:Risk; D015398:Signal Transduction; D054460:rho-Associated Kinases / Q000502:physiology
D047492:Peroxisome Proliferator-Activated Receptors; D054460:rho-Associated Kinases