Comparative Effects of Ischemic Preconditioning and Iron Chelation in Hepatectomy.
OBJECTIVE
Major hepatectomies can result in severe ischemia/reperfusion (I/R) injury of the liver. The aim of this survey is to comparatively evaluate the effects of a surgical and a pharmacological hepatoprotective modality on the liver remnant in a porcine model of hepatectomy.


METHODS
Twenty-one Landrace pigs were randomly divided into three groups: a control group (CON) (n = 7), an Ischemic Preconditioning (PRE) group (n = 7) and a Desferoxamine (DFX) treated one (n = 7). Animals were subjected to 120 min of liver ischemia with subsequent 75% hepatectomy followed by 24-hr reperfusion. In all animals, continuous intracranial pressure (ICP) monitoring was employed. Blood samples were collected at t0, t6, t12, and t24 hrs after reperfusion. Liver remnant specimens were excised for histological examination.


RESULTS
In the PRE group, ICP was statistically lower at t6 time point compared to CON group and in comparison with t0. In addition, ICP was significantly lower at all-time points after reperfusion in the DFX group. Finally, with regard to DFX and PRE group correlation, ICP was significantly lower at t0, t12, and t24 time points after reperfusion in the DFX group. In the PRE group, NH3 levels were significantly lower at t12 after reperfusion compared to CON and DFX groups. Histological evaluation elucidated significantly less hepatocellular necrosis, apoptosis, and degeneration in the PRE and DFX groups correlated to CON group.


CONCLUSIONS
Both hepatoprotective modalities including PRE and DFX administration are associated with lower ICP levels and correlated with attenuated liver remnant injury.
a 4th Department of Surgery, Athens University, Medical School, ATTIKON University Hospital , Chaidari , Athens , Greece.
Georgios
G
Trogadas
a 4th Department of Surgery, Athens University, Medical School, ATTIKON University Hospital , Chaidari , Athens , Greece.
Aikaterini
A
Mastoraki
a 4th Department of Surgery, Athens University, Medical School, ATTIKON University Hospital , Chaidari , Athens , Greece.
Constantinos
C
Nastos
b Department of Pathology, Aretaieion Hospital, University of Athens Medical School , Athens , Greece.
Agathi
A
Kondi-Pafiti
c 2nd Department of Anesthesiology, Athens University, Medical School, ATTIKON University Hospital , Chaidari , Athens , Greece.
Georgia
G
Kostopanagiotou
a 4th Department of Surgery, Athens University, Medical School, ATTIKON University Hospital , Chaidari , Athens , Greece.
Vassilios
V
Smyrniotis
a 4th Department of Surgery, Athens University, Medical School, ATTIKON University Hospital , Chaidari , Athens , Greece.
Nikolaos
N
Arkadopoulos
D000818:Animals; D003676:Deferoxamine / Q000627:therapeutic use*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D007502:Iron Chelating Agents / Q000627:therapeutic use*; D019194:Ischemic Preconditioning; D008107:Liver Diseases / Q000209:etiology / Q000517:prevention & control*; D011897:Random Allocation; D015427:Reperfusion Injury / Q000209:etiology / Q000517:prevention & control*; D013552:Swine
D007502:Iron Chelating Agents; D003676:Deferoxamine
desferoxamine; hepatectomy; hepatoprotective modalities; intracranial pressure; iron chelation; ischemic preconditioning; swine