title: Effect of Remote Ischaemic Preconditioning on Liver Injury in Patients Undergoing Major Hepatectomy for Colorectal Liver Metastasis: A Pilot Randomised Controlled Feasibility Trial.
abstract: Liver resection produces excellent long-term survival for patients with colorectal liver metastases but is associated with significant morbidity and mortality from ischaemia reperfusion injury (IRI). Remote ischaemic preconditioning (RIPC) can reduce the effect of IRI. This pilot randomised controlled trial evaluated RIPC in patients undergoing major hepatectomy at the Royal Free Hospital, London.
  
  
  
  Sixteen patients were randomised to RIPC or sham control. RIPC was induced through three 10-min cycles of alternate ischaemia and reperfusion to the leg. At baseline and immediately post-resection, transaminases and indocyanine green (ICG) clearance were measured.
  
  
  
  The RIPC group had lower ALT and AST levels immediately post-resection (ALT: 43% lower 497 ± 165 vs 889 ± 170 IU/L; p = 0.019 AST: 54% lower 408 ± 166 vs 836 ± 167 IU/L; p = 0.001) and at 24 h (ALT: 41% lower 412 ± 144 vs 698 ± 137 IU/L; p = 0.026 AST: 50% lower 316 ± 116 vs 668 ± 115 IU/L; p = 0.02). ICG clearance was reduced in controls versus RIPC immediately after resection (ICG-PDR: 11.1 ± 1.1 vs 16.5 ± 1.4%/min; p = 0.035).
  
  
  
  This pilot study shows that RIPC has potential to reduce liver injury following hepatectomy justifying a prospective RCT powered to demonstrate clinical benefits.
authors.affiliation: Hepato-Pancreatico-Biliary and Liver Transplant Unit, University Department of Surgery, Royal Free Hospital, London, NW3 2QG, UK.|Department of Surgical and Interventional Science, Royal Free Campus, University College London, 9th Floor Royal Free Hospital, Pond Street, London, NW3 2QG, UK.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Kanoria
authors.affiliation: Hepato-Pancreatico-Biliary and Liver Transplant Unit, University Department of Surgery, Royal Free Hospital, London, NW3 2QG, UK. francis.robertson.13@ucl.ac.uk.|Department of Surgical and Interventional Science, Royal Free Campus, University College London, 9th Floor Royal Free Hospital, Pond Street, London, NW3 2QG, UK. francis.robertson.13@ucl.ac.uk.
authors.forename: Francis P
authors.initials: FP
authors.lastname: Robertson
authors.affiliation: Hepato-Pancreatico-Biliary and Liver Transplant Unit, University Department of Surgery, Royal Free Hospital, London, NW3 2QG, UK.|Department of Surgical and Interventional Science, Royal Free Campus, University College London, 9th Floor Royal Free Hospital, Pond Street, London, NW3 2QG, UK.
authors.forename: Naimish N
authors.initials: NN
authors.lastname: Mehta
authors.affiliation: Hepato-Pancreatico-Biliary and Liver Transplant Unit, University Department of Surgery, Royal Free Hospital, London, NW3 2QG, UK.|Department of Surgical and Interventional Science, Royal Free Campus, University College London, 9th Floor Royal Free Hospital, Pond Street, London, NW3 2QG, UK.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Fusai
authors.affiliation: Hepato-Pancreatico-Biliary and Liver Transplant Unit, University Department of Surgery, Royal Free Hospital, London, NW3 2QG, UK.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Sharma
authors.affiliation: Hepato-Pancreatico-Biliary and Liver Transplant Unit, University Department of Surgery, Royal Free Hospital, London, NW3 2QG, UK.|Department of Surgical and Interventional Science, Royal Free Campus, University College London, 9th Floor Royal Free Hospital, Pond Street, London, NW3 2QG, UK.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Davidson
mesh_terms: D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D015179:Colorectal Neoplasms / Q000473:pathology; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy; D006801:Humans; D019194:Ischemic Preconditioning / Q000379:methods*; D007866:Leg / Q000098:blood supply*; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015427:Reperfusion Injury / Q000517:prevention & control*
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase