Ischemic Preconditioning Protects Liver from Hepatectomy Under Hepatic Inflow Occlusion for Hepatocellular Carcinoma Patients with Cirrhosis

Overview

Journal World J Gastroenterol

Publisher Baishideng Publishing Group

Specialty Gastroenterology

Date 2004 Aug 10

PMID 15300911

Citations 22

Authors

Shao-Qiang Li

Li-Jian Liang

Jie-Fu Huang

Zhi Li

Affiliations

Soon will be listed here.

Abstract

Aim: To investigate the protective effect of ischemic preconditioning (IPC) on hepatocellular carcinoma (HCC) patients with cirrhosis undergoing hepatic resection under hepatic inflow occlusion (HIO) and its possible mechanism.

Methods: Twenty-nine consecutive patients with resectable 0HCC were randomized into two groups: IPC group: before HIO, IPC with 5 min of ischemia and 5 min of reperfusion was given; control group: no IPC was given. Liver functions, hepatic Caspase-3 activity, and apoptotic cells were compared between these two groups.

Results: On postoperative days (POD) 1, 3 and 7, the aspartate transaminase (AST) and alanine transaminase (ALT) levels in the IPC group were significantly lower than those in the control group (P<0.05). On POD 3 and 7, the total bilirubin level in the IPC group was significantly lower than that in the control group (P<0.05). On POD 1, the albumin level in the IPC group was higher than that in the control group (P = 0.053). After 1 h of reperfusion, both hepatic Caspase-3 activity and apoptotic sinusoidal endothelial cells in the IPC group were significantly lower than those in the control group (P<0.05).

Conclusion: IPC has a potential protective effect on HCC patients with cirrhosis. Its protective mechanism underlying the suppression of sinusoidal endothelial cell apoptosis is achieved by inhibiting Caspase-3 activity.

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References

Jaeschke H, Lemasters J . Apoptosis versus oncotic necrosis in hepatic ischemia/reperfusion injury. Gastroenterology. 2003; 125(4):1246-57. DOI: 10.1016/s0016-5085(03)01209-5. View

Natori S, Selzner M, Valentino K, Fritz L, Srinivasan A, Clavien P . Apoptosis of sinusoidal endothelial cells occurs during liver preservation injury by a caspase-dependent mechanism. Transplantation. 1999; 68(1):89-96. DOI: 10.1097/00007890-199907150-00018. View

Yoshizumi T, Yanaga K, Soejima Y, Maeda T, Uchiyama H, Sugimachi K . Amelioration of liver injury by ischaemic preconditioning. Br J Surg. 1999; 85(12):1636-40. DOI: 10.1046/j.1365-2168.1998.00917.x. View

Wanner G, Mica L, Kolb S, Hentze H, Trentz O, Ertel W . Inhibition of caspase activity prevents CD95-mediated hepatic microvascular perfusion failure and restores Kupffer cell clearance capacity. FASEB J. 1999; 13(10):1239-48. DOI: 10.1096/fasebj.13.10.1239. View

Belghiti J, Noun R, Malafosse R, Jagot P, Sauvanet A, Pierangeli F . Continuous versus intermittent portal triad clamping for liver resection: a controlled study. Ann Surg. 1999; 229(3):369-75. PMC: 1191702. DOI: 10.1097/00000658-199903000-00010. View

Selzner N, Rudiger H, Graf R, Clavien P . Protective strategies against ischemic injury of the liver. Gastroenterology. 2003; 125(3):917-36. DOI: 10.1016/s0016-5085(03)01048-5. View

Yadav S, Sindram D, Perry D, Clavien P . Ischemic preconditioning protects the mouse liver by inhibition of apoptosis through a caspase-dependent pathway. Hepatology. 1999; 30(5):1223-31. DOI: 10.1002/hep.510300513. View

GUJRAL J, BUCCI T, Farhood A, Jaeschke H . Mechanism of cell death during warm hepatic ischemia-reperfusion in rats: apoptosis or necrosis?. Hepatology. 2001; 33(2):397-405. DOI: 10.1053/jhep.2001.22002. View

Peralta C, Prats N, Xaus C, Gelpi E, Rosello-Catafau J . Protective effect of liver ischemic preconditioning on liver and lung injury induced by hepatic ischemia-reperfusion in the rat. Hepatology. 1999; 30(6):1481-9. DOI: 10.1002/hep.510300622. View

10.

Ogawa T, Mimura Y, Hiki N, Kanauchi H, Kaminishi M . Ischaemic preconditioning ameliorates functional disturbance and impaired renal perfusion in rat ischaemia-reperfused kidneys. Clin Exp Pharmacol Physiol. 2000; 27(12):997-1001. DOI: 10.1046/j.1440-1681.2000.03378.x. View

11.

Tang Z, Yu Y, Zhou X, Ma Z, Yang R, Lu J . Surgery of small hepatocellular carcinoma. Analysis of 144 cases. Cancer. 1989; 64(2):536-41. DOI: 10.1002/1097-0142(19890715)64:2<536::aid-cncr2820640230>3.0.co;2-x. View

12.

Kohli V, Selzner M, Madden J, Bentley R, Clavien P . Endothelial cell and hepatocyte deaths occur by apoptosis after ischemia-reperfusion injury in the rat liver. Transplantation. 1999; 67(8):1099-105. DOI: 10.1097/00007890-199904270-00003. View

13.

Sola A, de Oca J, Gonzalez R, Prats N, Rosello-Catafau J, Gelpi E . Protective effect of ischemic preconditioning on cold preservation and reperfusion injury associated with rat intestinal transplantation. Ann Surg. 2001; 234(1):98-106. PMC: 1421954. DOI: 10.1097/00000658-200107000-00015. View

14.

Cheng X, Jiang X, Liu Y, Peng C, Xu B, Peng S . Effect of ischemic preconditioning on P-selectin expression in hepatocytes of rats with cirrhotic ischemia-reperfusion injury. World J Gastroenterol. 2003; 9(10):2289-92. PMC: 4656480. DOI: 10.3748/wjg.v9.i10.2289. View

15.

Sasaki H, Matsuno T, Tanaka N, Orita K . Activation of apoptosis during the reperfusion phase after rat liver ischemia. Transplant Proc. 1996; 28(3):1908-9. View

16.

Enari M, Talanian R, Wong W, Nagata S . Sequential activation of ICE-like and CPP32-like proteases during Fas-mediated apoptosis. Nature. 1996; 380(6576):723-6. DOI: 10.1038/380723a0. View

17.

Clavien P, Yadav S, Sindram D, Bentley R . Protective effects of ischemic preconditioning for liver resection performed under inflow occlusion in humans. Ann Surg. 2000; 232(2):155-62. PMC: 1421123. DOI: 10.1097/00000658-200008000-00001. View

18.

Belghiti J, Noun R, Zante E, Ballet T, Sauvanet A . Portal triad clamping or hepatic vascular exclusion for major liver resection. A controlled study. Ann Surg. 1996; 224(2):155-61. PMC: 1235336. DOI: 10.1097/00000658-199608000-00007. View

19.

Gavrieli Y, Sherman Y, Ben-Sasson S . Identification of programmed cell death in situ via specific labeling of nuclear DNA fragmentation. J Cell Biol. 1992; 119(3):493-501. PMC: 2289665. DOI: 10.1083/jcb.119.3.493. View

20.

Man K, Fan S, Ng I, Lo C, Liu C, Wong J . Prospective evaluation of Pringle maneuver in hepatectomy for liver tumors by a randomized study. Ann Surg. 1997; 226(6):704-11; discussion 711-3. PMC: 1191142. DOI: 10.1097/00000658-199712000-00007. View