title: Impact of ischemic preconditioning on outcome in clinical liver surgery: a systematic review.
abstract: BACKGROUND
  Ischemia-reperfusion injury is a major cause of post-liver-surgery complications. Ischemic preconditioning (IPC) has been demonstrated to protect against ischemia-reperfusion injury. Clinical studies have examined IPC in liver surgery but with conflicting results. This systematic review aimed to evaluate the effects of IPC on outcome in clinical liver surgery.
  
  
  METHODS
  An electronic search of OVID Medline and Embase databases was performed to identify studies that reported outcomes in patients undergoing liver surgery subjected to IPC. Basic descriptive statistics were used to summarise data from individual clinical studies.
  
  
  RESULTS
  1093 articles were identified, of which 24 met the inclusion criteria. Seven topics were selected and analysed by subgroup. There were 10 studies in cadaveric liver transplantation, 2 in living-related liver transplantation, and 12 in liver resection. IPC decreases hepatocellular damage in liver surgery as determined by transaminases but does not translate to any significant clinical benefit in orthotopic liver transplant or liver resection.
  
  
  CONCLUSIONS
  Available clinical evidence does not support routine use of IPC in liver surgery as it does not offer any apparent benefit in perioperative outcome. Further clinical studies will need to be carried out to determine the subset of patients that will benefit from IPC.
authors.affiliation: Department of Surgery, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
authors.forename: Michael J J
authors.initials: MJ
authors.lastname: Chu
authors.affiliation: Department of Surgery, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
authors.forename: Ryash
authors.initials: R
authors.lastname: Vather
authors.affiliation: Maurice Wilkins Centre for Biodiscovery, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand ; School of Biological Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
authors.forename: Anthony J R
authors.initials: AJ
authors.lastname: Hickey
authors.affiliation: Department of Surgery, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand ; New Zealand Liver Transplant Unit, Auckland City Hospital, Private Bag 92024, Auckland 1023, New Zealand.
authors.forename: Anthony R J
authors.initials: AR
authors.lastname: Phillips
authors.affiliation: Department of Surgery, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand ; School of Biological Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand ; New Zealand Liver Transplant Unit, Auckland City Hospital, Private Bag 92024, Auckland 1023, New Zealand.
authors.forename: Adam S J R
authors.initials: AS
authors.lastname: Bartlett
mesh_terms: D002102:Cadaver; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D019194:Ischemic Preconditioning; D008099:Liver / Q000503:physiopathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D059035:Perioperative Period; D015427:Reperfusion Injury; D016896:Treatment Outcome