Protective effect of S-adenosylmethionine on hepatic ischemia-reperfusion injury during hepatectomy in HCC patients with chronic HBV infection.
BACKGROUND
Although hepatectomy is often performed with the Pringle maneuver, the problem of hepatic ischemia-reperfusion injury (HIRI) can also be serious. Thus, the present study was designed to investigate the protective effect of S-adenosylmethionine (SAMe) on HIRI, especially for patients with hepatocellular carcinoma (HCC) associated with chronic hepatitis B virus (HBV) infection and cirrhosis.


METHODS
Eighty-one HCC patients with chronic HBV infection, undergoing partial hepatectomy with inflow occlusion, were divided into three groups. In the pretreatment group (PR group, n = 26), patients were given SAMe two hours before surgery. In the post-treatment group (PO group, n = 25), patients were given SAMe six hours after surgery. And in the control group (control group, n = 30), patients received partial hepatectomy without any SAMe. All pre-, intra- and postoperative blood samples were collected to measure the plasma levels of transaminases, bilirubin and cytokines. The results were compared among the three groups.


RESULTS
There were no statistically significant intergroup differences observed in age, gender, hepatic inflow occlusion time and the results of liver function tests. Preoperative administration of SAMe (PR group) significantly reduced the plasma levels of alanine transaminase (ALT), aspartate transferase (AST), total bilirubin (TBIL) and direct bilirubin (DBIL) as compared to the other two groups. In the PO group, TBIL and DBIL were significantly lower than in the control group. Significant differences were also seen in IL-6 and TNF-α between the PR group and the other groups. In all groups, postoperative liver reserve function in the PR group as revealed by ICGR15 (Post ICGR15) was at its best before abdominal closure. Compared to the control group, the risk of complications and the hospital stay after surgery were significantly meliorated in the PR group. Additionally, patients with cirrhosis had a more acute rate of change in ALT and AST than non-cirrhotic patients.


CONCLUSIONS
Taken together, our preliminary findings suggest that preoperative administration of SAMe is useful and safe for reducing the HIRI in partial hepatectomy, especially for HCC patients whose disease is associated with chronic HBV infection and cirrhosis.
Guo-yan
GY
Liu
Wei
W
Wang
Anhui Key Laboratory of Hepatopancreatobiliary Surgery, 17 Lujiang Road, Hefei 230001, China. jwd1968@sina.com.
Wei-dong
WD
Jia
Ge-liang
GL
Xu
Jin-liang
JL
Ma
Yong-sheng
YS
Ge
Ji-hai
JH
Yu
Qi-kai
QK
Sun
Fan-long
FL
Meng
D014408:Biomarkers, Tumor / Q000378:metabolism; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000601:surgery* / Q000821:virology; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects*; D006509:Hepatitis B / Q000150:complications / Q000601:surgery* / Q000821:virology; D006515:Hepatitis B virus / Q000472:pathogenicity; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery* / Q000821:virology; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery* / Q000821:virology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D015427:Reperfusion Injury / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D012436:S-Adenosylmethionine / Q000627:therapeutic use*
D014408:Biomarkers, Tumor; D012436:S-Adenosylmethionine